Your physician
has determined that ERCP is necessary for further evaluation
of your condition. This has been prepared to help you better
understand the procedure. It includes answers to questions patients
ask most frequently. Please read it carefully. If you have additional
question, please feel free to discuss them with the endoscopy
nurse or your physician before the examination begins.
WHAT IS ERCP AND WHY IS IT DONE?
ERCP is a
specialized technique used to study the ducts (drainage routes)
of the gallbladder, pancreas and liver (the drainage channels
from the liver are called bile ducts or biliary ducts). An endoscope
(flexible thin tube that allows the physician to see inside
the bowels) is passed through the mouth, esophagus, and stomach
into the duodenum (first part of the small intestine). After
the common opening to the ducts from the liver and pancreas
is visually identified, a catheter (narrow plastic tube) is
passed through the endoscope into the ducts. Contrast material
("dye") is then injected gently into the ducts (pancreatic
or biliary) and x-ray films are taken. ERCP is used to diagnose
and treat many diseases of the pancreas, bile duct, liver and
gallbladder. Structural abnormalities suspected by symptoms,
physical examination, laboratory tests or x-rays can be shown
in detail and biopsies of abnormal tissues can be obtained if
necessary. ERCP can make the important distinction between whether
jaundice (yellow discoloration of the eyes and skin) is caused
by diseases that are treated medically such as hepatitis, or
structural diseases such as gallstones, tumors or strictures
(obstructing scar tissue) that are treated surgically or endoscopically.
In patients who are not jaundiced but have pain or laboratory
abnormalities suggesting biliary or pancreatic diseases, ERCP
may also provide important information. ERCP can determine whether
or not surgery is necessary and is helpful in providing the
anatomic detail the surgeon needs to plan an operation. The
information provided by ERCP is far more detailed than that
provided by standard x-rays or CT scans. Diagnostic ERCP is
the first step in therapeutic ERCP. Several conditions of the
biliary or pancreatic ducts can be treated (cured or improved)
by ERCP techniques that can open the end of the bile duct, extract
stones, and place stents (plastic drainage tubes) across obstructed
ducts to improve their damage.
WHAT PREPARATION IS REQUIRED?
It is necessary
to have a completely empty stomach for the best possible examination.
You should therefore fast for at least 4-6 hours before the
procedure. An allergy to iodine containing drugs (contrast material
or ñdyeî) is not a contraindication to ERCP, but
it should be discussed with your physician before the procedure.
The physician performing the procedure should be informed of
any medications you take regularly, any heart or lung conditions
(or any other major diseases), and whether you have any drug
allergies.
WHAT CAN BE EXPECTED DURING ERCP?
Your physician
will discuss why ERCP is being performed, potential complications
from ERCP, and alternative diagnostic or therapeutic tests that
are available. A local anesthetic may be applied to your throat
and an intravenous sedative will be given to make you more comfortable
during the test; most patients remember or feel very little
of the examination. Some patients may also receive antibiotics
before the procedure. The test begins with you lying face down
with your head to the right on an x-ray table. The endoscope
is passed through the mouth, esophagus and stomach into the
duodenum. The instrument does not interfere with breathing.
Air is introduced through the instrument and may cause temporary
bloating during and after the procedure. The injection of contrast
materials into the ducts rarely causes discomfort. The duration
of the test varies widely from 15 minutes to 2 hours.
WHAT ARE POSSIBLE COMPLICATIONS OF ERCP?
ERCP is generally
a well-tolerated procedure when performed by physicians who
have special training and experience in this technique.
PHLEBITIS or localized irritation of the vein into
which medications were given may rarely cause a tender lump
that may last several weeks. The application of heat packs or
hot moist towels may ease the discomfort. Major complications
requiring hospitalization can occur but are uncommon (less than
1%) during diagnostic ERCP. They include SERIOUS PANCREATITIS,
INFECTIONS, BOWEL PERFORATION AND BLEEDING. Another
potential risk of ERCP is an ADVERSE REACTION TO THE
SEDATIVE used. The risk of procedure vary with the
indications for the test, what is found during the procedure,
what therapeutic intervention is undertaken, and the presence
of other major medical problems, e.g. heart or lung diseases.
Your physician will tell you what is your likelihood of complications
before undergoing the test. It must be realized that stones
in the bile ducts can also lead to pain, serious pancreatitis
and infection if left untreated in some patients. If therapeutic
ERCP is performed (cutting an opening in the bile duct, stone
removal, dilation of a stricture, stent or drain placement,
etc), the possibility of complications is higher than with diagnostic
ERCP. Complications again included PANCREATITIS (3-7%),
BLEEDING REQUIRING A TRANSFUSION (3-5%), AND BOWEL PERFORATION
(1-2%). These risks must be balanced against the potential
benefits of the procedure and the risks of alternative surgical
treatment of the condition. Often these complications can be
managed without surgery, but occasionally they do require corrective
surgery.
WHAT CAN BE EXPECTED FOLLOWING ERCP?
If you are
having ERCP as an outpatient, you will be kept under observation
several hours until most of the effects of the medications have
worn off. Evidence of any complications of the procedure will
be looked for and hospitalization may be advised if further
observation or treatment is necessary. You may experience bloating
or pass gas because of the air introduced during the procedure.
You may resume your usual diet unless instructed otherwise.
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