Endoscopic retrograde cholangiopancreatography
(en-doh-SKAH-pik REHtroh-grayd  kohLANjee-oh-
PANG-kree-uh-TAH-gruh-fee)  (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.  The liver is a large organ that, among other things makes a liquid called bile that helps with digestion.  The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine.   These ducts are called the biliary tree. The pancreas is a large gland that produces enzymes that help with digestion. 

ERCP may be used to discover the reason for jaundice,
(yellowing of the skin), upper abdominal pain, and unexplained weight loss.  ERCP combines to use of x-ray and an endoscope, which is a long flexible, lighted tube. Through it the physician can see the inside the stomach, duodenum and ducts in the biliary tree and pancreas.

You will be asked to sign a consent form authorizing the physician to perform the procedure.

Please inform the doctor and the GI nurse if you are allergic to any medications.  It is very helpful to bring a list of your medications including over the counter drugs you take daily. 

For the procedure you will lie on your left side on the examining table in an x-ray room.  You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam.  You will swallow the endoscope and the physician will then guide the scope through your esophagus, stomach and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope.  Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x-rays.    A radiographer will begin taking x-ray as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or work around the obstruction. Also tissue samples (biopsy) can be taken for further testing. 

Possible complications of ERCP include pancreatitis (inflammation of the pancreas) infection, bleeding and perforation of the duodenum. However, such problems are uncommon. Please discuss these possible complications with your physician.

ERCP takes 30 minutes to 2 hours.  You may have some discomfort when the physician instills air into the duodenum and injects the dye into the ducts.  However, the pain medicine and sedative should keep you comfortable.   After the procedure you will feel drowsy and may sleep for a short time.  The physician will make sure you do not have signs of complications before you leave.  If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.  Before you leave the physician will discuss the findings with you.  The GI nurse will give you give written instructions to follow when your get home.  Also you MUST arrange for someone to take you home after the procedure--you will not be allowed to drive because of the sedatives.

Preparation:
Your stomach and duodenum must be empty for the procedure to be accurate and safe.  You will not be able to eat or drink anything after midnight the night before the procedure(or follow you physician's instructions).

Reference: Society of Gastoenterology Nurses and Associates, ERCP brouchure and Guide for Patients prepared by National Digestive Diseases Information Clearing House