how to prepare for ERCP

To prepare for ERCP, do not eat or drink for 8 hours before the test. Some of your medications may be stopped or adjusted. ERCP is a special procedure performed by a gastroenterologist to examine and treat diseases of the bile duct and pancreas.

What is an ERCP (Endoscopic Retrograde Cholangio-Pancreatography)?

This is a special procedure that uses a flexible tube called an endoscope with special features to examine and treat diseases of the bile duct and pancreas. The doctor inserts wires and catheters through the endoscope. Dye (contrast material) is injected and X-rays are taken. The doctor looks for any abnormality in the bile duct and pancreatic duct. If abnormalities are found, special procedures can be done to diagnose or treat the problem.

Why do you need an ERCP?

  • Treat bile obstruction that causes jaundice.
  • Investigate abnormal ultrasound, CT scan or MRI.
  • Remove gall stones from the bile duct (choledocholithiasis).
  • Treat acute cholangitis.
  • Evaluate pancreatitis of unknown cause.
  • Diagnose and treat cancers of the bile duct and pancreas.
  • Treat acute gallstone pancreatitis with associated bile obstruction or cholangitis.
  • Drain the gall bladder and bile duct.
  • Treat sump syndrome.
  • Diagnose and treat chronic pancreatitis.
  • Treat choledochocele that involves the major papilla.
  • Diagnose ampullary cancers.
  • Treat complications of laparoscopic cholecystectomy like bile leak.

What are the risks of ERCP

Risks of ERCP include reaction to sedation, breathing problems, nausea, vomiting, abdominal pain, headaches, heart problems, bleeding, perforation, pancreatitis (occurs in 3-5% of people) and death. The risks and benefits are discussed during consent before the test.

What are the alternatives to an ERCP?

Alternatives to ERCP are surgeries performed by a surgeon or per cutaneous drainage performed by an interventional radiologist.

How do I prepare for my test

What do I do 1 week before the ERCP?

  • Discuss all your medications with your provider.
  • You may need to stop your antiplatelet or anticoagulants such as Coumadin, Plavix.
  • You may continue to take your aspirin.
  • Arrange for a driver to take you home after the procedure.

What do I do 2-3 days before the ERCP?

  • You may need to stop anticoagulants like Eliquis, Pradaxa, and Xarelto 2-3 days before your ERCP.

What do I do a day before the ERCP?

  • Confirm your transportation with a responsible adult driver.
  • No solid food 8 hours prior to your procedure.

What do I do on the day of the ERCP?

  • You may take your essential morning medications with a few small sips of water, at least 4 hours before your procedure, unless as directed by your physician.
  • If you have diabetes mellitus and take insulin, your insulin dose will be adjusted. Do not take short-acting insulin while you’re fasting.
  • Nothing by mouth at least 4 hours prior to your procedure including gum, hard candies, mints, tobacco.
  • Leave your valuables at home.
  • Bring your ID, insurance cards, and any co-pay with you.

What to expect during the procedure

You will be given medicines to make you sleepy. Most people do not remember the test. You will be given oxygen and monitored throughout the test. You may be given an antibiotic before the procedure.

The doctor passes the flexible tube through your mouth and stomach into the first portion of the small intestine, where the opening into to the bile and pancreatic ducts is located. Then, the doctor inserts wires and catheters through the endoscope. Dye (contrast material) is injected and X-rays are taken.  Apart from studying the liver, gall bladder, bile duct and pancreas; interventions can be done. Stones can be removed. Stents and drains can be placed. Fluid can be aspirated and biopsies can be obtained.

For most people, the procedure last 1-3 hours.

What to expect after the procedure

You will be monitored until you are awake. You may eat or drink once you are awake. Your doctor may discuss your result with you and whomever came with you. You may be given a copy of your report. If biopsies are taken, it may take a few days for those results to come from the pathologist. Someone should drive you home.

If you develop severe abdominal pain, belly distention, fever, chills, vomiting or feel very sick after the procedure, contact your doctor immediately.


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