When you get to the endoscopy unit, you will answer questions about your medical history and your medications will be reviewed. You will talk with your doctor about the ERCP and any questions you have will be answered. An intravenous (IV) line will be put in, so you can get IV fluids, sleeping medications, and possibly pain medicine or antibiotics. You may need a breathing tube for general anesthesia, since the medications can make it hard for you to breathe on your own. You may be asked to remove any watches, jewelry, piercings, dentures, eyeglasses, or contacts prior to the test.
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 you are asleep, you should expect to be comfortable and very relaxed. You are unlikely to remember much of the test after this and most people feel fine afterwards.
Depending on what is seen during the ERCP, a lot of other tests or treatments can be done. These often include biopsies, widening the bile duct or pancreas duct openings (sphincterotomy), removing stones, and placing a tube (stent) across any narrowed areas. There are other treatments that may be done, and your doctor will tell you more about them. Depending on how hard your ERCP is, the time to do the procedure can be quick or may take several hours. 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 sleeping 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 kept at the hospital overnight for observation.
What are the Possible Complications of ERCP?
While ERCP is generally safe and most people do well, there are risks of having one. Your physician should discuss the potential risks with you prior to your procedure.
When Should I Call My Doctor?
- Bleeding may happen and is more common if the bile duct opening is widened by cutting. The bleeding is usually small and stops on its own. Sometimes patients can vomit blood or blood can pass through their stool as a sign of bleeding. (not sure if this would scare the reader but explaining symptoms may be helpful) If it happens during the ERCP, it can be treated during the procedure. This can be done with small metal clips, injection of epinephrine medicine (which constricts blood vessels), or by burning the bleeding area with electricity.
- Infection of the bile ducts (cholangitis) can occur, especially if the bile ducts are not draining well. Fevers and abdominal pain may be a sign of infection. Antibiotics during the procedure and for a few days following ERCP are needed for some patients.
- Pancreatitis (inflammation or irritation of the pancreas) occurs in 3% to 7% of all patients who have an ERCP. This will cause really bad stomach pain in the top of your belly going through to your back. This pain that does not get better by belching or passing gas. While most ERCP related pancreatitis is mild, it can rarely be very bad or even life threatening. You may have to stay in the hospital for to treat this.
- Perforation (a tear or hole) of the esophagus, stomach, small bowel, or ducts may happen. Worsening abdominal pain may be a sign of this. If this is small, it may heal on its own with closely watching you in the hospital. If it is big, then it may need endoscopy or surgery to fix it, which may cause more problems.
- Aspiration (stomach contents going into your lungs) may occur when food from the stomach refluxes into the back of the throat and is sucked down into the lungs. This can cause trouble breathing or a lung infection called pneumonia. This risk is small if patients do not eat for several hours prior to the procedure.
- Bad Reactionto the sleeping medicines or anesthesia. This could include rash, nausea, vomiting, or more severe reactions to medications. A review of prior allergies or side effects will be done prior to giving you any new medications.
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.
Updated by Royce Groce, MD, The Ohio State University, Columbus, OH, 2020.
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