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PROCEDURE INFORMATION

ERCP

What is ERCP?

ERCP is a study of the ducts that drain the liver and pancreas. Ducts are drainage routes into the bowel. The ones that drain the liver and gallbladder are called bile ducts.

Diagnostic ERCP is when X-ray contrast dye is injected into the bile duct, the pancreatic duct, or both. X-rays are taken during ERCP to get pictures of these ducts. Most ERCPs are done for treatment and not just picture taking. When an ERCP is done to allow treatment, it is called therapeutic ERCP.

What treatments can be during ERCP?

Stone Removal -The most common treatment through an ERCP scope is removal of bile duct stones. These stones may have formed in the gallbladder and traveled into the bile duct or may form in the duct itself years after your gallbladder has been removed.

Stent Placement – Stents are placed into the bile or pancreatic ducts to bypass strictures, or narrowed parts of the duct. These narrowed areas are due to scar tissue or tumors that cause blockage of normal duct drainage. There are two types of stents that are commonly used. The first is made of plastic and looks like a small straw. A plastic stent can be pushed through the ERCP scope into a blocked duct to allow normal drainage. The second type of stent is made of metal wires that looks like the cross wires of a fence. The metal stent is flexible and springs open to a larger diameter than plastic stents. Your doctor will choose the best type of stent for your problem.

Balloon Dilation – These are ERCP catheters fitted with dilating balloons that can be placed across a narrowed area or stricture. The balloon is then inflated to stretch out the narrowing. Dilation with balloons is often performed when the cause of the narrowing is benign (not a cancer). After balloon dilation, a temporary stent may be placed for a few months to help maintain the dilation.

Tissue Sampling – One procedure that is commonly performed through the ERCP scope is to take samples of tissue. Tissue samples can help decide if a narrowing, is due to a cancer. If the sample is positive for cancer it is very accurate.

What can you expect before, during, and after a therapeutic ERCP?

You should not eat for at least 6 hours before the procedure. You should tell your doctor about medications that you take regularly and whether you have any allergies to medications or contrast material.

You will have an IV placed in your arm so you can receive medicine during the procedure. You will be given sedatives that will make you comfortable during the ERCP. Some patients require antibiotics before the procedure. The procedure is performed on a X-ray table. After the ERCP is complete you will go to a recovery area until the sedation effects reside. Some patients are admitted to the hospital for a day but many go home from the recovery unit. You should not drive a car for the rest of the day although most patients can return to full activity the next day.

What are possible complications of therapeutic ERCP?

The overall ERCP complication rate requiring hospitalization is 6-10%. Depending on your age, your other medical problems, what therapy is performed, and the indication for your procedure, your complication rate may be higher or lower than the average. Your doctor will discuss your likelihood of complications before you undergo the test. The most common complication is pancreatitis, or inflammation of the pancreas. Other complications include bleeding, infection, an adverse reaction to the sedative medication, or bowel perforation. Most complications are managed without surgery but may require you to stay in the hospital for treatment.

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