Upon arriving at the endoscopy unit, you will answer questions about your medical history and your medications will be reviewed. The ERCP procedure will be thoroughly explained and you will be given a chance to ask any questions that you might have. An intravenous (IV) line will be placed in order to provide IV fluids, sedating medications, and possibly antibiotics. Depending on the unit and the situation, you may either undergo conscious sedation (moderate sedation), or general anesthesia. General anesthesia is administered by an anesthesia specialist and may require a breathing tube since it is a deeper level of sedation. You will be asked to remove any dentures or eyeglasses prior to being sedated.
You will be brought to the ERCP room and will be positioned on a special table that allows for x-rays to be taken. You will be asked to lie on your left side, stomach, or back. A small plastic mouthpiece will be placed in your mouth to help protect your teeth and gums. Once sedation is administered, you should expect to be comfortable and asleep or very relaxed. The procedure is generally well-tolerated and most people feel fine afterwards.
Depending on what is seen during the ERCP, a variety of techniques may be performed, including taking biopsies, widening the sphincter (sphincterotomy), removing stones, placing a stent (tube) across any narrowed areas, or other treatments. The length of the procedure varies from 30 minutes to over an hour. Air is introduced through the endoscope so that the endoscopist can see the inside of your stomach and intestine during the examination.
Once the procedure is finished, you will be brought to the recovery room and monitored while the sedative medications wear off. Sometimes patients feel mild abdominal discomfort from the air in the intestines. This is usually relieved by belching or passing gas. A sore throat is a fairly common complaint. It is treated with throat lozenges and typically resolves in one to two days. You may feel groggy or have difficulty concentrating, so patients are advised to rest for the remainder of the day. You will not be permitted to drive your car for the rest of the day. Depending upon how your initial recovery goes, you may be admitted to the hospital overnight for observation.
What are the Possible Complications of ERCP?
While ERCP is generally a safe and well-tolerated procedure, several risks are associated with it. Your physician should discuss the potential risks with you prior to your procedure.
When Should I Call My Doctor?
- Bleeding may occur, particularly if the papilla sphincter is cut. The bleeding is usually minimal and resolves on its own. If it occurs during the procedure, it can be treated with a variety of endoscopic techniques, including placement of hemoclips, injection of epinephrine (which constricts blood vessels), or use of cautery.
- Infection of the bile ducts (cholangitis) can occur, especially if the bile ducts are not draining well. Antibiotics during the procedure and for a few days following ERCP are indicated in certain patients.
- Pancreatitis (inflammation of the pancreas) occurs in 3% to 7% of all patients who undergo ERCP. This would be felt as more severe abdominal pain that does not get better by belching or passing gas. While most post-ERCP pancreatitis is mild, rarely, it can be severe and life-threatening, requiring hospitalization.
- Perforation (a tear or hole) of the esophagus, stomach, small bowel, or ducts may occur. While this is a rare complication that may heal on its own, it may be severe, and may even require surgery for repair.
- Aspiration may occur when food from the stomach refluxes into the back of the throat and is inhaled, causing difficulty breathing or pneumonia. This risk is minimized in patients who have fasted for several hours prior to the procedure.
- Adverse reaction to sedative medicines or anesthesia.
You should contact your doctor immediately if you experience any of the following symptoms after your ERCP:
- Fever or chills
- Severe abdominal pain
- Difficulty swallowing
- A crunching sensation underneath the skin
- Severe abdominal bloating with firmness and tenderness
- Bleeding (red, maroon or black stool, or vomiting blood)
If biopsies were taken during your test, you should follow-up as instructed by your physician to discuss the results.
Author(s) and Publication Date(s)
Oleh Haluszka, MD, and Jennifer L. Maranki, MD, Temple University, Philadelphia, PA – Published January 2012.
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