ERCP (Endoscopic Retrograde Cholangiopancreatography)

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If you have diabetes, ask your regular doctor for diet and medication restrictions.
If you take a medication to thin your blood and have not already discussed this with our office, please call us at 612-871-1145.
If you take aspirin, you may continue to do so.

Other Medications: The following medications may interact with the sedation used for your procedure. If you take any of these medications please call our office at 612-871-1145: crizotinib (Xalkori), enzalutamide (Xtandi), isocarboxazid (Marplan), linezolid (Zyvox), moclobemide, phenelzine (Nardil), procarbazine (Matulane), rasagiline (Azilect), selegiline (Emsam, Eldepryl, Zelapar), tranylcypromine (Parnate), mifepristone (Korlym, Mifeprex), boceprevir (Victrelis), conivaptan (Vaprisol), efavirenz (Sustiva), ketoconazole, sodium oxybate (Xyrem), telaprevir (Incivek).
If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.
You must arrange for a ride for the day of your exam. If you fail to arrange transportation with a responsible adult, your procedure will need to be cancelled and rescheduled.
If you must cancel or reschedule your appointment, please call 612-871-1145 as soon as possible.

PREPARATION
To ensure a successful exam, please follow all instructions carefully. Failure to accurately and completely prepare for your exam may result in the need for an additional procedure and both procedures will be billed to your insurance.

The night before your exam:

  • Stop eating solid foods at 11:45pm.
  • Clear liquids are okay to drink (examples: water, Gatorade, clear broth, apple juice).
  • Do not drink red liquids or alcoholic beverages.

The day of your exam:

  • Stop drinking clear liquids 6 hours before your exam.
  • You may take your usual morning medications with 4 oz. of water at least 2 hours prior to your procedure.

When you leave for your procedure:

  • Bring a list of all of your current medications, including any allergy or over-the-counter medications.
  • Bring a photo ID as well as up-to-date insurance information, such as your insurance card and any referral forms that might be required by your payer.
  • Co-pays are required on the day of your appointment.
  • Allergy to iodine-containing drugs (contrast material or "dye") is not a contraindication to ERCP, but should be discussed with your physician the day of your procedure.
  • If ERCP will be done on an outpatient basis, a responsible adult must drive and accompany you home from the procedure because of the sedation used during the examination.

DESCRIPTION OF ERCP (endoscopic retrograde cholangiopancreatography)

What is an ERCP?
ERCP is a specialized technique used to study the ducts (drainage routes) of the liver, gallbladder, and pancreas (the drainage channels from the liver are called bile ducts or biliary ducts). When performed by physicians with special training in this procedure, ERCP can be accomplished in 90-95% of patients.

ERCP is a valuable tool that is used for diagnosis and treatment of many diseases of the pancreas, bile ducts, liver, and gallbladder. Structural abnormalities such as gallstones, tumors, or strictures (obstructing scar tissue) can be shown in detail and biopsies of abnormal tissue can be obtained if necessary. In some cases ERCP can be used to determine whether or not surgery is necessary and may be helpful in providing the anatomic detail the surgeon needs to plan an operation when surgery is necessary. Several conditions of the biliary or pancreatic ducts can be treated (cured or improved) by therapeutic ERCP techniques that can open the end of the bile duct, remove stones, and place stents (plastic drainage tubes) across obstructed ducts to improve their drainage.

What should I expect during an ERCP?
Plan to spend up to three hours at the hospital the day of your ERCP. The exam itself takes approximately 30 to 90 minutes to complete. Before the exam, you will be asked about your medical history, and a nurse will insert an intravenous (IV) line into your hand or arm.

During the exam, you will be given medicine through the IV line to help you relax. In certain situations, you may receive general anesthesia. You will lie on your left side, and your heart rate and oxygen levels will be monitored continuously. Some patients also receive antibiotics before the procedure. The doctor will insert a flexible, hollow tube - called an endoscope - into your mouth and will advance it slowly through the esophagus, stomach and duodenum (the first part of your small intestine). The instrument does not interfere with breathing. Air is introduced through the instrument and may cause temporary bloating during and after the procedure. After the opening to the ducts is visually identified, a catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast material ("dye") is then injected gently into the ducts (pancreatic or biliary) and x-rays are taken. The injection of contrast into the ducts or removal of a stone may occasionally cause discomfort.

What should I expect after an ERCP?
The doctor will prepare a full report for the physician who referred you for the ERCP. If you are having an ERCP as an outpatient, you will be kept under observation until most of the effects of the medications have worn off. If you have been given medications during the procedure you will not be allowed to drive, take a taxi, or ride the bus. A responsible adult must drive and accompany you home from the procedure because of the sedation used during the examination. Evidence of any complications of the procedure will be looked for and hospitalization may be advised if further observation is necessary. Your throat may feel sore for a short time. You may feel bloated after the procedure. This is normal. On discharge, you will receive specific instruction on when to resume your usual diet and medications.

What are possible complications of ERCP?
ERCP is generally a well-tolerated procedure when performed by physicians who have had special training and experience in this technique. However all procedures carry some risk. In ERCP, intravenous (IV) sedation is used, and localized irritation of the vein into which medications were given may cause a tender lump that may last days to weeks. The application of heat packs or hot moist towels to the area may ease the discomfort. An adverse reaction to the sedative may occur, including allergic reactions and changes in breathing, blood pressure, and heart rate.

Additional complications specific to ERCP can occur, including pancreatitis, infection, bowel perforation (a small hole in the digestive tact), and bleeding. The risks of the procedure vary with the indications for the test, what is found during the procedure, what therapeutic intervention is undertaken, and the presence of other major medical problems, such as heart or lung diseases. Published studies show the risk of pancreatitis is 5-10%, and the risk of infection, bleeding, and perforation are all less than 1%. If a complication does occur, it may result in hospitalization, blood transfusion, repeat procedure, or occasionally corrective surgery. Your physician will discuss the likelihood of complications with you before undergoing the test.

 

Rev 11/25/2013