The task of the common bile duct is to ensure that the bile reaches the duodenum from the liver and gallbladder together with the pancreatic common duct. The pancreatic duct allows pancreatic fluids to reach the duodenum. The common bile duct and pancreatic duct usually unite in the pancreatic tissue and open into the duodenum through a structure called the ampulla. The most common reason a person needs ERCP is because one of these ducts is blocked (usually due to gallstones). Usually, blood tests and noninvasive imaging tests such as ultrasound, computed tomographic (CT) scanning, or magnetic resonance imaging (MRI) were performed prior to ERCP.

An endoscopist (a doctor specially trained in the use of an endoscope) will examine the bile and/or pancreatic ducts for obstruction, tissue irregularity, problems with bile or pancreatic fluid flow, stones, or tumors. If a problem is found, the endoscopist can usually perform a procedure to repair or improve the condition; as a result, ERCP has replaced surgery in most patients with common bile duct and pancreatic disease.

Many patients who need ERCP are hospitalized, but ERCP can also be done as an outpatient procedure, depending on the patient’s condition and the complexity of the procedure required.

ERCP Preparation

You will be asked not to eat or drink anything for six to eight hours before the test. It is important that the stomach is empty so that the endoscopist can see the entire area and reduce the chance of vomiting during the procedure.

You may be asked to adjust the dose of your medications or stop taking certain medications before the exam. Most medications can be continued as usual, but some medications need to be discontinued for a few days. All medications and dietary supplements should be discussed with your provider, as some are more important than others; for example, if you are taking a blood-thinning medication, the provider will determine how and when you should stop it before ERCP. If you have diabetes, your morning medication doses (tablets or insulin) will be adjusted as you cannot eat anything before your ERCP.

If you are pregnant, ERCP should be postponed until after delivery if possible, but the procedure can be done safely during pregnancy if it is urgent.

You will need a friend or family member to accompany you home after the examination. This is because medications used for sedation can impair reflexes, judgment, and your ability to drive (similar to the effects of alcohol).

Expectations from the Endoscopy Unit

Before the endoscopy, you will be asked questions about your medical history and the medications you are currently using, and the results of your blood tests will be checked; The ERCP procedure will also be explained in detail and the doctor will verify that the consent form has been signed.

Sedation — The nurse will create an intravenous line to administer medications. Most endoscopy units use a combination of a sedative to induce relaxation and a medication to prevent discomfort. This is called “conscious sedation” because you are awake, but the body relaxes and the pain is numbed. In some more complex situations, you may be more heavily sedated or given anesthesia (sedation) for ERCP.

For safety reasons, you will be asked to remove glasses or contact lenses and dentures. You may be given a local anesthetic (a numbing spray applied to the throat or gargled) before the procedure begins.

ERCP process

ERCP is performed in a room containing X-ray equipment. During the exam, you will lie on a special table, usually on your left side or stomach.

Although many people are concerned about the discomfort from endoscopy, most people tolerate it well.

The ERCP endoscope is a special flexible tube approximately the size of a finger. It contains a lens and a light source that allows the endoscopist to see inside the patient’s body; images are enlarged on a monitor so that even minute details and changes can be seen. The endoscope also contains channels that allow the endoscopist to take biopsies (painless tissue samples) and to take or take fluid, air, or other instruments.

You will be asked to swallow the tube; Most people have no difficulty with this as a result of sedative medications. After the scope is placed through the mouth, air is gently introduced to open the esophagus, stomach, and intestine so that the binoculars can be passed through these structures and allowed the endoscopist to see. A small plastic tube (cannula) is passed through the endoscope through a structure called the papilla into the mouth of the bile duct, dye is injected, and after injection X-ray pictures are taken and displayed on a TV monitor so that the endoscopist can examine the bile ducts and pancreatic duct.

Depending on what the endoscopist sees during ERCP, he or she may perform a variety of procedures or treatments. If there are bile duct stones in the common bile duct, the opening of the papilla can be widened by applying electrocautery, and sometimes the stones are removed with the help of a net. If X-ray pictures show narrowing of the bile duct, a stent (a small wire mesh or plastic tube) may be placed to allow bile to bypass the obstruction and pass into the duodenum.

You may feel a slight discomfort as air enters through the endoscope. It is not harmful and may relieve the burping sensation. The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure can help you relax.

The length of the examination ranges from 30 to 90 minutes (usually about an hour).

Recovery after ERCP

After ERCP, you will be monitored until the sedatives wear off. Medications cause most people to feel temporarily tired or have difficulty concentrating, so it is generally recommended not to return to work or drive that day.

The most common discomfort after the examination is the feeling of bloating as a result of air entering during the examination. This usually resolves quickly. Some people also have a mild sore throat. Most people can drink clear liquids shortly after the exam. In some cases, blood tests may be done the same day following ERCP.

The endoscopist can usually tell the patient the results of the examination immediately. If a biopsy was taken, the tissue will need to be sent to a lab for analysis.

ERCP complications

ERCP is a safe procedure and serious complications are rare. If complications do occur, they are usually mild. Complications such as pancreatitis, bleeding, intestinal perforation, and cholangitis can be seen at a very low rate. All details will be explained to you before the procedure.

ERCP is a procedure that should be done in experienced centers. With today’s technology and opportunities, we can now solve many problems that were previously solved by surgery, endoscopically.

Each patient is unique and should be evaluated separately.