Endoscopic
Retrograde Cholangiopancreatography (ERCP)
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What is the
test?
This procedure uses x-rays and an endoscope
to see inside your digestive system and diagnose
problems such as tumors, gallstones, and inflammation
in your liver, gallbladder, bile ducts, or pancreas.
Your doctor might use the test to investigate
the cause of jaundice, upper abdominal pain,
or unexplained weight loss.
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How
do I prepare for the test?
For a week before the test, don't take aspirin
or other NSAIDs because they can irritate the
stomach lining and increase your chance of bleeding
during the procedure. Also tell the doctor if
you are taking blood-thinning medicines or any
diabetes medications. People with heart valve
problems may also have to take antibiotics before
the procedure. Avoid eating or drinking anything
for eight hours before the test because it needs
to be done on an empty stomach.
Tell your doctor if you are allergic to iodine,
which is used for the procedure. Arrange for
someone to drive you home because the medication
given during the test will make you drowsy.
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What
happens when the test is performed?
The test is performed by a specially trained
gastroenterologist either in the doctor's office
or in a hospital. You are usually given a sedative
through an IV line. You wear a hospital gown
for the procedure and lie on your side against
a backrest on an x-ray table. If you wear dentures,
remove them. A local anesthetic is sprayed into
your throat to prevent you from having a gag
reflex (choking feeling) when the endoscope is
placed inside. The endoscope is about a third
of an inch in diameter and 21/2 feet long with
a light on the end. It also has holes at the
end that allow your doctor to pump air into your
intestine, squirt fluid, and suck out liquid
or air.
You are asked to swallow at the moment the tube
is placed into your throat. This helps guide
the endoscope into your esophagus.You are likely
to feel pressure against your throat while the
tube is in place and you might experience a "full" feeling
in your stomach. The doctor or doctor's assistant
gently advances the tube until it reaches your
duodenum, the first part of the small intestine.
Next, the doctor inserts a slender tube, called
a cannula, through the endoscope, and places
the tip of the cannula into the bile duct or
the pancreatic duct. These ducts are natural
tubes of tissue that drain liquids out of the
liver and pancreas. Once the tip of the cannula
is lodged inside one of these ducts, the doctor
injects contrast dye (usually iodine) through
the cannula. The dye can be seen by x-rays, so
it lights up the ducts clearly on an x-ray image,
showing any obstruction (such as from gallstones
or cancer) or unusual widening of the ducts (indicating
an obstruction in the past). It also can light
up the gallbladder, which connects to the bile
duct, and helps the doctor to visualize the liver
and pancreatic tissue around the ducts.
Depending on what the x-rays show, the doctor
may undertake different interventions using tools
operated through the endoscope. The doctor can
remove gallstones or take biopsies of suspicious
tissue. He or she can prop open narrowed bile
ducts with a stent, a tube-shaped object that
can be inserted through the scope. Depending
on what is done, the test can take from 30 minutes
to two hours.
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What
risks are there from the test?
Complications are rare. One possibility is aspiration-accidentally
inhaling saliva into the lungs - which can cause
pneumonia. Other risks include inflammation of
the pancreas, infection, and bleeding. Injury
to the lining of the stomach, esophagus, or intestine,
as well as abdominal pain and fever, can also
occur.
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Must
I do anything special after the test is over?
You are usually watched for 30 minutes or more
after this test. Typically, you can go home after
the sedation wears off, which takes about an
hour or two. Follow the precautions for sedation.
You can drink clear fluids when your gag reflex
returns, which can take two to four hours. Avoid
eating solid foods for 24 hours. It's important
to call your doctor if you experience dizziness,
chest pain, abdominal pain, back pain, difficulty
or pain with swallowing, fever, black-colored
or tarry stools, or vomiting of material that
looks like coffee grounds. The last two symptoms
can be signs of internal bleeding.
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How
long is it before the result of the test is
known?
It usually takes a day or two to get the results,
but in an emergency they can be ready in an hour.
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