What is ERCP? (Endoscopic-Retrograde-Cholangio-Pancreatography)

An ERCP is a specialized examination of the biliary tree and pancreas.


Why do I need the procedure?

This test will help your doctor to evaluate your biliary tree and pancreas. Treatment may be performed at the same time if indicated and where technically possible. For example, a stone blocking the bile duct may be removed and stent may be inserted if there is blockage of the bile duct.


What does it involve?

It is performed on an empty stomach, after at least six hours without food and drink. ERCP is done in an x-ray room, with you lying on your front. Injection of mild sedation is given. This will put you into a light sleep during the procedure. Your pulse and oxygen level will be monitored with a finger-probe throughout the procedure. The endoscope is then gently introduced. You will be able to breathe easily throughout. The entire procedure takes between 30 and 60 minutes, and depending on whether treatment is carried out.


The endoscope is steered into the small intestine to reach the opening of the bile duct. A cannula (fine, hollow tubing) is then inserted through the endoscope into this opening through which a dye is then injected. The dye outlines the bile ducts, gallbladder and pancreatic duct, which can be seen under x-ray screening. Treatment may also be undertaken at the same time, through the endoscope. For removal of a stone from the bile duct, the opening of the duct needs to be enlarged by a small cut using electrocautery. This part of the procedure is called sphincterotomy. Special instruments can then be passed through the endoscope to crush and retrieve the stone from the bile duct.


What are the possible complications from an ERCP?

An ERCP is a moderate risk procedure. Inflammation of the pancreas (acute pancreatitis) can result from irritation of the pancreatic duct by the dye and it occurs at risk of 3%. This usually settles by itself but 0.1% of patients may experience severe pancreatitis necessitating admission to the intensive care unit. Excessive bleeding (1%) can result from cutting of the opening of the duct (sphincterotomy). Perforation or tears of the intestinal wall (1%) can also occur during sphincterotomy if the cut is too deep. Surgery may be needed to correct these compilations. Rarely, all these complications may be fatal (0.1%). You may experience some temporary throat discomfort after the procedure. The risks of sedation include lowering blood pressure, lowering oxygen level and slowing down breathing. This is minimized by using the appropriate dose of sedative and monitoring of pulse and oxygen levels. Please discuss any specific concerns you may have with your doctor.


What can I expect after an ERCP?

When ERCP is completed you will be brought back to the ward or recovery area. You will be closely monitored to look out for discomfort and potential complications. You will not be allowed food or drink for at least 4 hours after ERCP.


Is there an alternative test?

The alternatives to ERCP are MRCP (Magnetic Resonance Cholangio-Pancreatogram) or EUS (Endoscopic Ultrasound). MRCP uses magnetic waves to obtain a picture of the bile ducts and pancreas. EUS involves insertion of an endoscope with an attached ultrasound device. An ultrasound scan of the bile ducts and pancreas is done from inside the digestive passage. Both these tests are also useful to find out what is wrong. The main drawback is that treatment through the scope cannot be carried out at the same time and an ERCP may then be needed if abnormalities are detected with MRCP or EUS.


What should I do with my current medication before the procedure?

You need to inform your list of medication (including traditional medicine) to your doctor. In general, you need to stop blood thinning medicines (such as clopidrogel, warfarin, Xarelto, Pradaxa) before the procedure. Your doctor will advise you number of days you need to stop the medication. You also need to inform your prescriber whether it is safe to stop these medication temporarily. Another group of medication which you need to stop before the procedure are diabetic medicines.



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    +65 6732 7710

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