What is endoscopic retrograde cholangiopancreatography?

ERCP is a way to examine your pancreas, pancreatic duct, common bile duct, and/or sphincter of Oddi. Your doctor uses a long narrow tube called an endoscope to look at these parts of your body and he or she may use contrast dye and x- rays to highlight them. Your doctor may also use ERCP to try to remove any stones or blockages he or she may find.

Your common bile duct connects your liver, gallbladder, and pancreas to your small intestine. Your pancreatic duct connects your pancreas to your common bile duct. The sphincter of Oddi is a circular muscle where your common bile duct enters your small intestine. It opens and closes to allow fluid to pass into your small intestine to help with digestion.

When is it used?

The doctor may suggest this procedure if:

• You have particular forms of jaundice.
• He or she suspects you have a stone lodged in the common bile duct.
• You have a blockage in the pancreatic duct.
• You have a sphincter of Oddi that is too tight.
• You have a growth of tissue in the bile duct or pancreatic duct.

Examples of alternatives are:

• Having a common bile duct exploration
• Having a CT scan of the abdomen
• Having similar x-rays done through a needle placed into the bile duct through the liver (a procedure called a percutaneous transhepatic cholangiogram: PTC)
• Choosing not to have treatment, while recognizing the risks of your condition.

You should ask your doctor about these choices.

How do I prepare for an ERCP?

Follow the doctor's instructions. Eat a light meal the night before the operation and do not eat or drink anything after midnight the night before the procedure. Plan for care and recovery time after the operation is over.

What happens during the procedure?

You will be given a sedative to relax you. The doctor will insert a tube into your throat and down your esophagus (swallowing tube) and guide it through your stomach and small intestine until it reaches the point at which the common bile duct opens into the intestine (the sphincter of Oddi).

The doctor will pass a smaller tube through the first tube and guide it up the common bile duct to look for stones, narrow places, or blocked portions. The doctor will use fluoroscopy, a motion picture x-ray, to guide the tube.

The doctor may inject some dye into your common bile duct and/or pancreatic duct to highlight any abnormal growths or structures on an x-ray.

If the x-ray or tube uncovers stones, the doctor may use a tool to break them and move them into the intestine.

The doctor may also enlarge the opening of the sphincter of Oddi by cutting into the muscle wall to allow the stones to pass through to the intestine more easily.

What happens after the procedure?

You will be observed for about 1 hour and then may go home. Because you should not drive or do anything that requires coordination or quick response, you should have someone pick you up from the hospital.

If the doctor cut into the sphincter, you will need to stay overnight in the hospital.

Ask your doctor what steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

Your doctor may understand your problem better and be able to suggest further care.

You may get relief from the problem. If you have an obstruction, the doctor may relieve it without having to resort to abdominal surgery, with its accompanied discomfort, risks, longer hospital stay, and expense.

What are the risks associated with this procedure?

• Your esophagus, stomach, intestine and/or common bile duct may be hurt or punctured.
• You may develop inflammation in the liver, common bile duct, or pancreas.
• The procedure may not work: if there is a blockage or if you have stones, your doctor may not be able to clear either one.
• There is a risk of infection and bleeding.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You develop severe abdominal pain.
• You feel nauseated.
• You vomit.
• You develop a fever.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.