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Diagnostic Tests
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Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (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 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.
ERCP may be used to discover the reason for jaundice, upper abdominal pain, and unexplained weight loss. ERCP combines the
use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the
stomach, duodenum, and ducts in the biliary tree and pancreas.
For the procedure, you will lie 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 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. A radiographer will begin taking x-rays as soon as the dye is injected.
If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or
work around 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. However, 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 or weeks.
ERCP takes 30 minutes to 2 hours. You 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 keep you from feeling too much discomfort. After the
procedure, you will need to stay at the physician's office for 1 to 2 hours until the sedative wears off. The physician will
make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing
a gallstone, you may need to stay in the hospital overnight.
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. You must also arrange
for someone to take you home--you will not be allowed to drive because of the sedatives. The physician may give you other
special instructions.
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and
Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive
disorders and to their families, health care professionals, and the public. NDDIC answers inquiries; develops, reviews, and
distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate
resources about digestive diseases.
Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies
as desired.
e-text posted: 7 July 1998
