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Endoscopic Retrograde Cholangiopancreatogram (ERCP)

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the website Healthwise, authored by Healthwise Staff (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

What is an ERCP?

An endoscopic retrograde cholangiopancreatogram (ERCP) test checks the tubes (ducts) that drain the liver, gallbladder and pancreas. A flexible, lighted scope (endoscope) and X-ray pictures are used.

The scope is put through the mouth and gently moved down the throat. It goes into your oesophagus, stomach and duodenum until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum. X-rays will then be taken.

ERCP can treat certain problems found during the test. In some cases, your doctor can insert small tools through the scope to:

• Take a sample of tissue (biopsy) from an abnormal growth. Then it can be checked for problems.
• Remove a gallstone in the common bile duct.
• Open a narrowed bile duct: a narrowed bile duct can be opened by inserting a small wire-mesh or plastic tube (called a stent) in the duct.

Why an ERCP is done

Endoscopic retrograde cholangiopancreatogram (ERCP) is done to:

• Check lasting belly pain or jaundice.
• Find gallstones or diseases of the liver, bile ducts, or pancreas.
• Remove gallstones from the common bile duct if they are causing problems. These may include a blockage (obstruction), inflammation or infection of the common bile duct (cholangitis), or pancreatitis.
• Open a narrowed bile duct or insert a drain.
• Get a tissue sample for further testing (biopsy).
• Measure the pressure inside the bile ducts (manometry).

How to prepare for an ERCP

Follow the instructions exactly about when to stop eating and drinking, or your test may be cancelled. If your doctor told you to take your medicines on the day of the test, do so using only a sip of water.

If your doctor prescribed antibiotics before the test, take them as directed. You need to take the full course of antibiotics.

Tell your doctor if you:

• Have hay fever, hives, food or medicine allergies, or asthma.
• Are allergic to shellfish (shrimp, scallops, lobster). Also tell your doctor if you are allergic to iodine, such as that used in the contrast material for X-ray tests.
• Have had a digestive tract study that used barium, such as a barium enema, within the last week.
• Take a blood thinner, or if you have had bleeding problems. You may need to stop these medicines for a while before you have the test.

You will be asked to empty your bladder. You will also need to remove any dentures, jewellery, or contact lenses before you have this test.

How an ERCP is done

An endoscopic retrograde cholangiopancreatogram (ERCP) is usually done by a gastroenterologist. This is a doctor who has special training in diseases of the digestive system. The doctor must be trained in endoscopy. A thin, flexible fiber-optic endoscope (scope) is used.

This test is done in the hospital. You may have to stay overnight if your doctor takes out gallstones or places a stent during the test. Otherwise, you can go home after the test.

An ERCP usually takes 30 to 60 minutes. You will be in the recovery room 1 to 2 hours.

Your throat may be numbed with an anaesthetic spray, gargle, or lozenge to relax your gag reflex. This makes it easier to insert the scope. Shortly before the test begins, an intravenous (IV) line will be placed in a vein in your arm. You will get pain medicine and a sedative through the IV during the test. You may also get an antibiotic through the IV.

You will need to lie on your left side. Your head will be tilted slightly forward. A mouth guard may be inserted to protect your teeth from the scope. The scope's tip will be lubricated. The doctor will guide it into your mouth while gently pressing your tongue out of the way. You may be asked to swallow to help move the tube along. The scope is no thicker than many foods you swallow.

When the scope is in your oesophagus, your head will be tilted upright to help the scope slide down. Then your doctor will slowly move the scope into your stomach and duodenum. Your doctor looks at all three of these areas as the scope moves forward. When it reaches your duodenum, you will be turned over to lie flat on your belly.

A small amount of air will be injected through the scope. This makes it easier for the doctor to see. The doctor will move the scope forward until it reaches the point where the ducts from the pancreas and gallbladder drain into the duodenum. A thin tube called a catheter is then passed through the scope into that area. Then contrast material is injected into the bile or pancreatic ducts. Several X-rays are taken. You will stay on your belly until the X-rays are ready to view. If needed, the doctor may take more X-rays.

The doctor may insert small tools through the scope. This allows the doctor to take a tissue sample, remove a gallstone, open a narrowed bile duct, or place a stent.

When the test is done, the scope is slowly withdrawn.

After the test

After the test, you will be observed in a recovery room. You may have gas, feel bloated and notice a temporary change in your bowel habits for a while. This is because air was used to open the bile and pancreatic ducts. Call your doctor if you have bleeding from the rectum or if your stools look black or bloody.

You may also have a dry and tickling throat, slight hoarseness, or a mild sore throat for several days. Using throat lozenges and gargling with warm salt water can help relieve your throat symptoms. If your throat was numbed before the test, you will not be allowed to eat or drink until your throat is no longer numb. You will need to be able to swallow without choking. You can then eat and drink normally.

Because of the IV medicines used during this test, do not drink alcohol, drive, or sign any legal documents for 24 hours after the test.

If your doctor removed a gallstone or placed a stent during the test, you may need to stay a night in the hospital. You cannot drive or return to work for 24 hours. If you can go home the day of the test, you will need to have someone drive you.

Your doctor will check for signs of problems before you go home.

How an ERCP feels

You may notice a brief, sharp burning or stinging when the IV is started in your arm. The local anaesthetic sprayed into your throat usually tastes slightly bitter. It will make your tongue and throat feel numb and swollen. Some people report feeling as though they cannot breathe sometimes because of the tube in their throat. This is a false sensation caused by the anaesthetic. There is always plenty of breathing space around the tube in your mouth and throat. Remember to relax and take slow, deep breaths.

You may gag, feel nauseated or bloated, or have mild belly cramps as the tube is moved. If the discomfort is severe, alert your doctor with an agreed-upon signal or tap on the arm. Even though you won't be able to talk during the test, you can still communicate.

The IV medicines will make you feel sleepy. You may not be able to remember much of what happens during or for several hours after the test. You may have heavy eyelids, trouble speaking, a dry mouth, or blurred vision for several hours after the test.

You may feel flushed when the contrast material is injected.

Risks

Complications are not common. But having this test may cause serious problems, such as:

• Inflammation of the pancreas (This is called pancreatitis).
• Bleeding: This may occur if the pancreatic or bile ducts were widened, if a stent was placed, or if biopsies were taken.
• Infection of the bile ducts, which may occur if gallstones were removed.
• Infection of the blood (This is called sepsis).
• An abnormal heart rhythm.
• A puncture of the oesophagus, stomach, duodenum, bile duct, or pancreatic duct. If this happens, you will need to have surgery to repair the puncture.
• Problems caused by anaesthesia.

After the test

After the test, call your doctor right away if you:

• Have nausea or vomiting.
• Have new or increased belly pain.
• Get a fever or chills.
• Feel short of breath.
• Are dizzy or feel like you may faint.

People who have serious heart disease and older adults who have other chronic diseases have a greater chance of having problems from this test. Talk to your doctor about your specific risks.

ERCP results

An endoscopic retrograde cholangiopancreatogram (ERCP) is a test that combines the use of a flexible, lighted scope (endoscope) with X-ray pictures to examine the tubes that drain the liver, gallbladder and pancreas.

Normal ERCP

• Contrast material shows normal structure and size of the bile ducts and the ducts that drain the liver, gallbladder, and pancreas.
• The oesophagus, stomach and duodenum look normal.
• Pressure in the ducts is normal.

Abnormal ERCP

• The ducts are narrowed or blocked: This may be caused by gallstones, scar tissue, inflammation or cancer.
• Inflammation, ulcers, infection, or pseudocysts are seen.
• Cancer of the oesophagus, stomach, duodenum, gallbladder, or pancreas is found.
• Pressure in the ducts is not normal.

Your doctor may be able to tell you about some findings right after the test. But the medicines used to relax you for the test may impair your memory. So your doctor may tell you to call the next day for your results.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

• You have barium contrast material in your intestines. This may be from a barium enema test.
• You have an infection such as pancreatitis or diverticulitis.
• You are pregnant.
• You can't stay still during the test.

What To Think About

Depending on the ERCP results, you may need other tests to confirm a diagnosis. These may include angiography or laparoscopy.

If you have belly pain or jaundice, your doctor might suggest that you have a different test before you have ERCP. It may be a test that costs less or can be done without entering the body. This may include a CT scan, an MRI scan or an abdominal ultrasound.

An imaging test called magnetic resonance cholangiopancreatogram (MRCP) can show the bile ducts and help diagnose medical conditions. But doctors can't do biopsies or treatment during an MRCP.

An endoscopic ultrasound (EUS) test has a small ultrasound probe at the end of the scope. It may offer a more detailed view of parts of the digestive tract than ERCP. EUS also lets the doctor see certain organs of the body near the digestive tract. These include the pancreas and bile ducts. EUS may help diagnose noncancerous (benign) or cancerous (malignant) tumours of the oesophagus, stomach, pancreas, and bile ducts.

About the source

Healthwise Staff
Medical Reviewers:

• Gregory Thompson, MD - Internal Medicine
• Adam Husney, MD - Family Medicine
• Jerome B. Simon, MD, FRCPC, FACP – Gastroenterology

Current as of March 28, 2018

References

1. Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
2. Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
3. Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

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