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Overview

This examination is used to diagnose and sometimes treat problems with the bile ducts and pancreatic ducts. These are tubes that carry fluids from the liver, gallbladder and pancreas into the small intestine where they are needed for digestion.

ERCP is used mainly to diagnose and treat problems within the biliary tree such as gallstones, inflammatory strictures (scars that cause narrowing), leaks (from injury or surgery), and cancers. The exam combines the use of a special type of x-ray called fluoroscopy and an endoscope (a long, thin, flexible, lighted tube with a tiny TV lens). The physician can enter the duodenum (the part of the small intestine where the bile ducts empty) with the scope and inject dye into the biliary tree and see the structures under the x-ray.

Preparation

You should not have anything to eat or drink after midnight the night before the exam. During your pre-exam visit and again the morning of your exam, let the doctor know of any allergies, especially to contrast dye. Be sure the doctor knows what medicines you are taking as some medicines such as blood thinners, aspirin and anti-inflammatory are held up to five to seven days prior to procedure. On the day of your exam, please remove all jewelry. You may wear dentures to the hospital but they will have to be removed for the exam.

You will need to arrive at the hospital's Outpatient Surgery Unit (located just inside the main entrance) one hour prior to the procedure. You will need to recover at the hospital one to two hours after the procedure. Please be sure to arrange a ride home and plan to rest at home for the entire day of the procedure.

Procedure

You will be sedated to relax you and relieve any discomfort. You will have an IV (intravenous line) placed in your arm in order to receive sedation. The exam is done in a special x-ray room with you lying on your stomach. You may have your throat sprayed to numb it and take away the gag reflex. After sedation, the scope is passed through your mouth into the esophagus, stomach, and duodenum until it reaches the place where the bile ducts empty. The doctor then guides tiny instruments through the scope. If stones are found in the bile ducts, these instruments can be used to enlarge the opening of the ducts and remove the stones. Some tissue samples (biopsies) may also be taken for further study in the laboratory. Generally, ERCP takes one to two hours.

Possible complications include pancreatitis (inflammation of the pancreas, infection, bleeding or perforation (puncture) of the duodenum. These complications are uncommon. You may experience some discomfort from air being blown into the small intestine, but the sedative and pain medicine should help this discomfort.