What is endoscopic retrograde cholangiopancreatography?
Endoscopic retrograde cholangiopancreatography (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 substance called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.

When is upper ERCP used?
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

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 for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye used.

How is upper ERCP performed?
For the procedure, you will lie prone on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative or anesthesia 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. X-rays are taken as soon as the dye is injected. Balloons, stents, biopsies, and other special techniques can be applied to treat problems with an ERCP.

What problems can upper ERCP detect?
If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve 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. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.
An ERCP takes 30 minutes to 2 hours. The patient may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should alleviate the discomfort.

Recovery from ERCP
After the procedure, the patient will need to stay at the hospital for 1 to 2 hours until the sedative wears off or overnight stay may be required. The physician will make sure there are no signs of complications before leaving. If any kind of treatment is done during an ERCP, such as removing a gallstone, the patient may need to stay in the hospital overnight.
Arrangement for a ride home is a must since the patient will not be allowed to drive because of the sedatives. The physician may give other special instructions before leaving.

Preparations for Procedures

 

Informed Consent
Informed consent will be obtained for any elective procedure performed by Dr. Llaneza. The patient will receive a full disclosure of the procedure, alternatives, risks, and possible consequences at the time of the visit. Please refer to the procedure descriptions listed under “Procedure Tab” in this website.