How an ERCP is Performed
An endoscopic retrograde cholangiopancreatography, or ERCP, is typically performed at a hospital. A trained physician leads the operation, often receiving assistance from other trained hospital personnel.
Preparation for ERCP
Before an ERCP, the patient will be given a list of specific things to do to prepare. Since the gastrointestinal tract must be clear for the procedure, the patient will be asked not to drink or eat anything for at least eight hours prior to the procedure. The patient will also be asked not to chew gum or smoke. In some cases, patients may be asked not to take certain medications or vitamins, as they may interfere with the anesthesia or other aspects of the procedure.
When the patient enters the room for ERCP, the first thing that they will be asked to do is gargle or spray a local anesthetic into their throat. This numbs the throat, mitigating any discomfort and reducing the natural gag reflex. The patient will then be asked to lie down on their back or side. If a sedative is being administered, an intravenous needle will be inserted in the arm.
Once the sedative has taken effect, the physician will carefully insert an endoscope into the patient’s mouth. The endoscope is then moved through the esophagus, through the stomach, and into the duodenum. The duodenum is the first part of the small intestine. Once the endoscope reaches the Papilla of Vater, which is where the pancreatic duct and bile duct meet, the doctor stops the endoscope.
The endoscope that is used during ERCP is lighted, and equipped with video equipment, allowing the doctor to examine the ducts as it is moved through them. To allow space for visual inspection, air is often pumped through the endoscope, inflating the stomach.
A tube, called a catheter, is inserted into the center of the endoscope. A certain type of dye is then run through the catheter, allowing the ducts to be highlighted on x-rays. This provides another way for doctors to spot blockages and restrictions within the ducts. In some cases, tools may also be moved through the endoscope during ERCP to allow immediate treatment of conditions. This is considered therapeutic ERCP.
Examples of what a doctor may accomplish during a therapeutic ERCP include:
- Drain blocked areas
- Extract gallstones
- Stretching of narrow ducts
After ERCP Procedure
After ERCP is performed, the patient will be given about an hour in a recovery room to allow the sedatives to wear off. Patients may not remember this period of time. After ERCP, patients often feel tired, and should plan to rest during the remainder of the day. They may also experience nausea or bloating from the air that is pumped through the endoscope during the procedure. A sore throat is also common for a day or two. Patients can usually resume normal eating habits following ERCP.
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