Endoscopic Retrograde Cholangiopancreatography (ERCP) in Utah

Your physician at Utah Gastroenterology will provide instructions before your ERCP procedure regarding what to expect and how to prepare your body for the test. In most cases, you can eat your normal diet the day prior to the procedure. You will be advised not to drink or eat after midnight except for medications. It is crucial to adhere to the directions given to you by your doctor. Additional instructions surrounding your medications will be given. In most cases, your medication regimen will be followed as usual. However, in certain circumstances, especially in individuals on blood thinners, (i.e., warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and with diabetics, special instructions will be discussed.

We will ask you to arrive at our endoscopy office in Utah 1 – 1.5 hours before your scheduled ERCP exam. This will give you plenty of time to fill out the required patient forms and prepare yourself for the evaluation. You will be asked to change into a medical gown. An intravenous (IV) catheter will be placed in your arm to allow sedation to be given. We will also utilize equipment that will enable the physician and staff to monitor your pulse, heart rate, blood pressure, breathing oxygen, and electrocardiogram levels throughout the course of and after the exam.

After you enter the exam room, you will then lie down on your stomach on the stretcher. The IV sedation will be administered at this point. When compared to other endoscopic assessments, it is not uncommon for general anesthesia to be administered for this exam. To ensure your safety and comfort, your specialist will administer small doses of sedation at a time. Once a sufficient sedation level is reached, the endoscope will be carefully introduced into the mouth. The scope will be carefully forwarded through the esophagus and down into the stomach and small intestine to the location where the bile and pancreatic ducts empty into the small intestine. A small portion of air is injected via the scope into the gastrointestinal system to enhance visibility. With an ERCP procedure, contrast dye is placed into the bile duct and the pancreatic duct. A radiographic (x-ray) imaging machine is utilized to capture images of the bile duct and pancreatic duct to determine if there are any abnormalities or concerns. Any fluid remaining in the upper gastrointestinal structures can be suctioned out through the scope device. Based upon what the procedure reveals, a few things can be conducted during the course of the evaluation, such as biopsies, stent placement (metal/plastic tubes) into the bile or pancreatic ducts, sphincterotomy (opening the bile or pancreatic duct), and the removal of gallstones from the bile ducts or stones from the pancreatic ducts. At the end of the procedure, as much of the air and residual fluid as possible will be removed via the scope. On average, the ERCP process takes between 30 – 90 minutes to complete based on the results.

Once the exam is complete, you will be taken to the recovery area to be monitored while the sedative effects of the medication start to fade away. The extent of sedation utilized during the ERCP exam and how you respond to it will dictate how fast you wake up; however, most individuals are awake enough for discharge within 45 – 60 minutes. You will not be able to operate any vehicles for the rest of the day and should, therefore, arrange for a ride home in advance. You will also be directed not to perform strenuous activities, sign important documents, or work for the rest of the day. In most cases, patients can eat and drink as normal after being released from the endoscopy unit, though important instructions surrounding eating, medications, and activity will be given prior to dismissal. At times, ERCP patients may need an overnight hospital stay for monitoring or evaluation.

The physician and/or support staff will go over the conclusions of your ERCP once your test procedure is finished. The majority of individuals will not recall what is discussed after the evaluation due to the effects of the sedation. Our Utah Gastroenterology staff recommends you have someone with you with whom the outcomes can also be discussed, if possible. You will also be provided with a typed report and will be advised of any test or biopsy results typically within one week.

For the most part, ERCP is a safe test. Any complications that do occur are generally not known to be severe, but some issues may require hospitalization and surgery. Before the start of the ERCP exam, a consent form will be reviewed with you by the clinical team. Treatment risks will again be rediscussed by the doctor before the procedure gets underway, and any questions or concerns can be discussed.

Acute pancreatitis is the most predominant complication. The condition may affect 5 – 8% of patients, although, depending on the patient, the risk can run up to 20%. Pancreatitis symptoms often include nausea, vomiting, pain in the abdominal area, and in some cases fever. The majority of cases are not severe and require a hospital stay of four days or less. During the hospital stay, patients generally only require IV fluids along with nausea and pain control. A small percentage of the time, however, pancreatitis can be more severe and even life-threatening.

Medication reactions from the sedation can arise. Such reactions can involve difficulty breathing, effects on blood pressure and the heart, irritation of the blood vessel used to administer the sedative, and allergic reactions. Bleeding may result from a sphincterotomy or biopsy procedures. Significant bleeding, which may necessitate a blood transfusion or hospitalization, is not a common occurrence.

Puncturing or perforation of the esophagus, stomach, or small bowel can take place. Such an occurrence may not be recognized at the time of the procedure, or it might not be recognized until a later time. The majority of the time, a puncture of this type will require hospitalization and surgery. However, this is a highly uncommon complication, even in the event where biopsies are taken or a sphincterotomy is performed.

Finally, among 5 – 10% of patients, the evaluation might not be able to be completed for varying reasons. It is strong advised that you get in touch with the doctor’s office right away should any form of symptoms arise following the procedure, such as fever, worsening abdominal pain, or bleeding.

Similar to any other testing process, endoscopic retrograde cholangiopancreatography is not flawless. There is a small, accepted risk that disease, including malignancies, may not be noticed with the procedure. It is imperative to continue to consult your medical providers as instructed and let them know of any new or ongoing symptoms or issues.

If you are in need of an ERCP in Utah, our GI doctors can help you find the optimal solution for you.

Alternatives to an ERCP may be available in certain cases, but available options will depend on the underlying reason for requesting the ERCP in the first place. For the majority of individuals, the ERCP process is the best approach to detect and treat certain issues in the pancreatic and biliary structures. However, an x-ray called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or echo-endoscopy or endoscopic ultrasound (EUS) can also assess the biliary ducts and pancreatic ducts. The magnetic resonance cholangiopancreatography is only a diagnostic procedure. Addressing any abnormalities will need to be accomplished through an ERCP or a surgical approach. Moreover, EUS or PTC do have treatment alternatives.