Endoscopic Retrograde Cholangiopancreatogram (ERCP): A Brief Overview

An Endoscopic Retrograde Cholangiopancreatogram (ERCP) is a therapeutic endoscopic procedure that helps diagnose and treat diseases in the liver, gallbladder, pancreas, and bile system. Here’s what you need to know about the procedure. 

When an ERCP is used

There are several reasons your doctor may perform an ERCP. One common reason is to diagnose and treat gallstones that are trapped in the bile duct. They may also perform an ERCP to identify the source of persistent upper right side abdominal pain, to identify a cause of pancreatitis, or to relieve bile duct obstruction caused by tumors. Often, doctors will inject a dye in the bile ducts during an ERCP to assist with X-ray imaging.

Preparing for an ERCP

There are a few important steps to prepare for an ERCP. You will need to discuss any medications you are taking with your doctor. Blood-thinning medications like Coumadin (warfarin), Eliquis (apixaban), Lovenox (enoxaparin), Plavix (clopidogrel), Pradaxa (dabigatran), and Xarelto (rivaroxaban) are especially important to discuss. These can increase the risk of severe bleeding during the procedure, and you should stop taking them before the ERCP. Also, if you use insulin, you may need to adjust timing or dosage on the day of the procedure. Your doctor will also need to know if you have any allergies to medications. Additionally, you will need to fast starting the midnight prior to your procedure. This means avoiding eating from that time until your procedure. 

During the Procedure

Prior to the ERCP procedure, you will go to a pre-op area where nurses will place an IV and take your medical information. You will also speak with an anesthesiologist about the sedation used during the procedure. 

Once you have moved to the procedure room, you will be connected to machines that monitor your vitals during the ERCP. You will be sedated during the procedure. Your doctor will feed the endoscope through your mouth and perform the procedure. The specific techniques and treatments they use will depend on your situation, and include opening blocked ducts and inserting stents. They may also take X-rays during the procedure. Contrast dye is injected through the endoscope to assist in developing X-ray imaging of your bile ducts. In total, the ERCP should take around 30-40 minutes. 

After the Procedure

After the ERCP, you will go to a post-op area to recover from sedation and the procedure and will be monitored for complications. Once you have recovered, your doctor will discuss the results with you, though any biopsies will take a few days to return. You should not operate machinery, drive, or make important decisions for 24 hours after your procedure due to sedative effects. 

It’s common to have a sore throat immediately after the procedure; throat lozenges can help treat soreness. You should follow a clear liquid diet after the ERCP, eventually transitioning to bland foods. 

The procedure has a few uncommon risks. Around 7% of patients experience pancreatitis, an inflamed pancreas. This requires hospitalization to rest the pancreas and manage inflammation. In very rare cases, this can be severe and lead to surgery, organ failure, or death. 

In very rare cases, perforation occurs during the procedure. Most of the time, this can be managed with hospitalization, bed rest, antibiotics, and bowel rest. Rarely, you may need surgery to repair the perforation. 

There is a low risk of bleeding as well, which occurs in around 0.5% of cases. When managed during the procedure, it can be stopped. Delayed bleeding requires patients to return to their doctor for treatment. 

Our experienced team at GHP has years of experience performing ERCPs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Dr. William Evans Discusses Pancreatitis

Dr. William Evans offers diagnostic and therapeutic care for conditions involving the GI tract, pancreas, and liver.  He provides his patients with comprehensive care that has been honed through years of specialized training and experience.

On this episode of KET’s Kentucky Health, Dr. Evans thoroughly discusses the pancreas as well as pancreatitis.

What is the Pancreas?

The pancreas is an organ that aids in the digestion of food. Located behind the stomach and deep in the abdomen, inflammation of the pancreas can affect all the important organs that surround it and even cause paralysis of the intestines. The two main functions of the pancreas are to regulate blood sugar and to make a enzyme fluid that helps digest any proteins or fats that are consumed. Pancreatitis is a disease that occurs when the pancreas becomes inflamed.

Causes of Pancreatitis 

  • Excessive Alcohol Abuse
  • Certain Medications
  • High Cholesterol
  • Gallstones or Gallbladder Disease (The most common cause.)
  • Virus or Traumatic Injury: (While not very common, viruses or traumatic injuries can result in pediatric cases of pancreatitis.) 
  • Distended Belly or Bloating (Present in more significant cases due to inflammation.)

Symptoms of Pancreatitis 

  • Abdominal Pain (Severe and focused on one’s back, especially triggered when eating.)
  • Nausea or Vomiting

Acute Vs. Chronic Pancreatitis 

Anyone can have acute pancreatitis. The most common cause of acute pancreatitis is trapped gallstones blocking the flow of pancreatic juice. In acute pancreatitis, inflammation can be so profound that the organ digests itself. Long term complications include a severe episode where one must be admitted to a hospital and kept for a few days, the death of the pancreas itself, a build up fluid that can become infected, as well as an impact on multiple other organs.

Chronic pancreatitis is most commonly associated with risk factors such as regular alcohol or tobacco use. Chronic pancreatitis can take months to develop and is often asymptomatic. In chronic pancreatitis cases, scar tissue builds up in the pancreas surrounding the nerves and causing pain. Overtime, one can lose function of the gland as well as the ability to digest food, and are at an increased risk for diabetes as well as pancreatic cancer. 

Pancreatic cancer is the 4th leading cause of cancer related deaths in the United States affecting those 45 or older. Signs of pancreatitis cancer include unexplained weight loss, a history of smoking, no obvious cause of pancreatitis, and a family history of the disease.   

Diagnosing & Treating Pancreatitis

Diagnosing pancreatitis often involves a basic exam, medical history, lab work and imaging. A CT scan of the abdomen can show if a stone is causing blockage or if a tumor is present. If a gallstone is a factor, an endoscopy may be required. With little if any food intake, pancreatitis usually takes 3-5  days to resolve, and an additional 6 weeks for the pancreas itself to normalize.

In order to avoid pancreatitis, abstaining from smoking and drinking is recommended. Educating one’s self on gallstones is also a helpful resource in preventative care, as one can have them removed if they become problematic.

Watch the full episode of Dr. William Evans on Kentucky Health here: 


Dr. William Evans earned his Medical degree from St. George’s University School of Medicine in Grenada, West Indies.  He completed his clinical training at the University of Louisville, where he completed an Internship, a Residency in Internal Medicine, and Fellowship in Gastroenterology.  During his fellowship training, Dr. Evans also earned a Masters in Science & Clinical Investigation at the University of Louisville School of Public Health & Information Sciences.  Dr. Evans went on to complete a second Fellowship in Therapeutic Endoscopy at the University of Florida College of Medicine in Gainesville, Florida.