PREPARATION BEFORE PROCEDURE:

• You will be asked not to eat or drink anything eight hours before your ERCP as an empty stomach allows for the best and safest procedure.
• You will have to tell all details pertaining to your medical history, allergies and medications. Certain medications like blood thinners need to be stopped few days before ERCP as they can increase the risk of bleeding. Few others need an adjustment in their dosages and timing.

DURING ERCP:

• You will be asked to lie down on your stomach or on your back. You will be connected to a monitor. You may require an anesthetist to keep you sedated if the procedure is going to be prolonged. A local anaesthetic is sprayed in your throat and a plastic mouth guard is inserted to hold your mouth open.
• Your doctor will gently insert the endoscope into the esophagus and gradually advance it into your stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to see. The doctor then locates the opening where the bile and pancreatic ducts empty into the duodenum.
• A thin flexible tube called catheter is inserted through the endoscope to the main bile duct/pancreatic duct entering the duodenum. Dye is then injected into the ducts to visualize them.X-ray films (fluoroscopy) are taken to examine the ducts and look for narrowed areas or blockages.
• The doctor may pass additional tools through the endoscope to remove stones by an incision made to widen the duct as it enters the duodenum and to place small tubings, called stents, in these areas to keep them open, to perform a biopsy, to replace/remove an old stent. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.
• The procedure may last for 30 to 90 minutes, depending on the complexity of the procedure.

AFTER PROCEDURE:

• The doctor will explain the results of your procedure. If a biopsy is taken the results of the same usually take few days to be ready.
• You might be asked to stay till the effect of sedative medication wears off. Even if you feel alert after the procedure, your judgement and reflexes could be impaired for the rest of the day. Hence someone must drive you home and stay with you.
• You might have a mild bloating sensation due to air introduced during endoscopy. You may also experience sore throat and cramping.
• You will be asked to start taking food as per your doctor’s recommendation.
• If a stent is placed in either your bile duct or pancreatic duct, you will be given a date to get it removed or replaced with a different stent as and when required.

COMPLICATIONS:

ERCP is a well-tolerated procedure when performed by doctors who are specially trained and experienced in the technique. Although complications requiring hospitalization can occur, they are uncommon.

• Pancreatitis: This could happen because the pancreas and bile ducts lie close to each other
• Bleeding especially if an incision is necessary
• Perforation in the bile or pancreatic ducts
• Infection in the bile or pancreatic ducts and gallbladder.
• An abnormal reaction to the sedative, including respiratory or cardiac problems

WHEN TO CALL THE DOCTOR:

• Fever
• Severe abdominal pain
• Difficulty in breathing
• Difficulty in swallowing or throat pain that gets worse
• Vomiting—particularly if your vomitis bloody or looks like coffee grounds
• Bloody or black, tar-colored stool