Endoscopic Retrograde Cholangiopancreatography (ERCP) in Washington

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Washington Gastroenterology performs endoscopic tests to diagnose several types of digestive health disorders in patients. An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure where a slender, flexible tube or “scope” is positioned into the mouth and advanced to the first portion of the small intestine, the duodenum. The scope has a light and a camera which allows the provider to assess the internal tissues of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An ERCP test may be completed to diagnose the cause of GI concerns, including:

  • Pancreatitis
  • Abnormal results from a liver test
  • Abnormal x-ray results
  • Pain in the abdominal area

Reach out to our Washington team today to request a consultation with a gastroenterology specialist near you to learn more about an endoscopic retrograde cholangiopancreatography.

What are the benefits of an ERCP?

An ERCP may be advised if blood tests show abnormal liver results, if you have inflammation of the pancreas, or if you have issues such as pain in the abdomen or yellowing of the eyes and skin. Some benefits of this test are:

  • Diagnostic and therapeutic: An ERCP may serve dual objectives, helping doctors detect diseases or conditions and perform treatment during the same process. As such, this can diminish the need for multiple treatments.
  • Reduced recovery periods: Individuals commonly experience faster recovery times with an ERCP compared to conventional surgical approaches, enabling a faster return to normal daily activities.
  • Enhanced precision: An ERCP helps facilitate the precise visualization of and treatment within the biliary and pancreatic ducts. This is vital for correct diagnosis and treatment of a condition.
  • Efficiency: The opportunity to diagnose and treat a health concern within one procedure generally decreases the overall treatment time for patients.

You will receive specific instructions from your Washington Gastroenterology provider regarding how to prepare and what to expect. In most cases, you can eat as you usually do the day prior to the exam. Patients will be advised not to drink or eat after midnight except for medications. It is crucial to follow the instructions given by your provider. Additional information surrounding your medications may be provided. In most cases, your medication schedule will be followed as usual. However, in certain circumstances, especially in those taking anti-coagulants (such as aspirin, anti-inflammatories, warfarin, Plavix®, and Coumadin®) and in diabetic patients, specific instructions will be discussed.

You will need to enter the endoscopy center in Washington 1 – 1.5 hours before your assessment. This time will be used to complete paperwork and prepare for the evaluation. You will be asked to change into a medical gown. Our clinical team will place an intravenous (IV) line in your arm to provide sedation. We will also connect you to equipment to enable your provider and our team to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen levels during and after the procedure.

Once in the exam room, you will be asked to lie on your stomach on the bed. Your IV sedation will then be administered. A small dose will be provided at a time to ensure that you do not have an adverse reaction to the sedation medication and to provide only the dosage you need on an individual basis. Compared with other endoscopic evaluations, it is not unusual for general anesthesia to be performed for an ERCP exam. The endoscope device will be inserted into the mouth when the appropriate sedation status is established. The endoscope will slowly advance through the esophagus, into the stomach and small intestine, and to where the bile and pancreatic ducts empty into the small intestine. A small amount of air is administered via the endoscope into the gastrointestinal tract to increase visibility. With an ERCP exam, radiographic contrast dye is administered into the biliary and pancreatic ducts. An x-ray machine is utilized to take clear pictures of the bile and pancreatic duct to detect any abnormalities. Any residual fluid in the upper GI structures can be removed via the scope. Depending on what the findings reveal, several processes may be carried out during the test, including biopsies, sphincterotomy (opening the bile duct or pancreatic duct), removal of gallstones from the bile ducts or stones from the pancreatic ducts, or placement of stents (plastic/metal tubes) into the bile duct or pancreatic duct. Once the procedure is complete, as much of the remaining fluid and air as possible will be withdrawn using the endoscope device. Based on the findings, the evaluation takes approximately 30 – 90 minutes.

After the exam, you will be taken to the recovery area to be assessed while the sedative effects begin to wear off. The amount of sedation utilized throughout the ERCP exam and how you respond to it will affect how quickly you wake up. Still, most individuals are awake enough for discharge within 45 – 60 minutes. You will not be able to operate any vehicles for the remainder of the day; therefore, you will need to have a relative or friend drive you home. You will also be instructed not to work, perform strenuous activities, or sign important papers for the remainder of the day. Most of the time, individuals can consume foods and beverages as usual after being dismissed from the endoscopy unit. However, specific instructions regarding eating, activity, and medications will be given before discharge. Occasionally, ERCP patients will be admitted for an overnight hospital stay for assessment or monitoring.

Following the ERCP procedure, the specialist and/or nursing staff will discuss the assessment results with you. Most individuals do not recall what is discussed after the ERCP procedure because of the effects of the sedation. If possible, our Washington Gastroenterology team strongly encourages you to bring someone with you to whom the ERCP outcomes can also be explained. You will also be provided with a typed synopsis and typically informed of any biopsy or other test results within a week.

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In general, ERCP is known to be a very safe test. In most situations, any complications that arise are not life-threatening; however, should a complication occur, it might require surgery and hospitalization. Before the start of the ERCP evaluation, the clinical team will review the consent for treatment form with the patient. The provider will again discuss the risks before the procedure begins, and any concerns or questions can be addressed at that time.

Acute pancreatitis, or inflammation of the pancreas, is the most predominant complication. This condition may develop in 5 – 8% of cases; however, depending on individual factors, the risk can run as high as 20%. Pancreatitis signs and symptoms may include nausea, vomiting, pain in the abdominal area, and in some instances, fever. Most cases are not severe and require four or fewer days in the hospital. During the hospital stay, patients often only need nausea, pain control, and IV fluids. In very few cases, however, pancreatitis can be more concerning and even life-threatening.

Medication reactions resulting from sedation can occur. These can include but are not limited to irritation of the vein used to give the medication, effects on the heart and blood pressure, allergic reactions, and breathing difficulties. Bleeding can be a result of a sphincterotomy or biopsies. Significant bleeding, which could require a blood transfusion or hospitalization, is not common.

The puncturing or perforation of the esophagus, stomach, or small intestine can occur. Such an occurrence may not be recognized at the time of the test, or it might not be recognized until later in the day. In most situations, a perforation will lead to a hospital stay and surgery. However, this is a rare complication, even when biopsies or a sphincterotomy is performed.

Finally, in 5 – 10% of cases, the endoscopic retrograde cholangiopancreatography assessment might not be able to be completed for several reasons. It is imperative to contact the provider’s office immediately if any symptoms occur following the test, such as increased abdominal pain, bleeding, or fever.

As with any other exam, ERCP is not flawless. There is a minor, accepted risk that health problems, including cancers, may not be identified during the exam. It is critical to continue care with your medical providers as recommended and let them know of any persistent or new symptoms.

Should you need an ERCP in Washington, our gastroenterologists can help you select the optimal options for your needs.

To a certain degree, the alternatives to endoscopic retrograde cholangiopancreatography will depend on the reason for requiring the ERCP in the first place. The ERCP process is the leading method for most patients to assess and address irregularities in the pancreatic and biliary structures. However, a radiographic (x-ray) image called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can also assess the biliary ducts and pancreatic ducts. However, magnetic resonance cholangiopancreatography is only used for diagnostics. Any abnormalities must be treated through an endoscopic retrograde cholangiopancreatography or a surgical procedure. Treatment options are available with the PTC or EUS.

What questions might be helpful to ask your provider about ERCP?

If you discover that you require an ERCP, you will probably have many questions and might not know where to begin. A few questions to ask your physician might include:

  • What does your doctor anticipate finding during this procedure?
  • What is the general success rate of an ERCP procedure?
  • If a complication should arise, what symptoms or signs might you notice?
What should you not do after an ERCP?

You cannot operate a vehicle for 24 hours after having an ERCP as the anesthesia might take that long to fully leave your system. As such, it is imperative to have a family member or friend drive you home from your appointment. You may be instructed to hold off on eating for a certain timeframe depending on the form of treatment performed during your ERCP. Our team may also advise that you take the rest of the day and possibly the next day off work to recover. Our Washington Gastroenterology team will help you understand what to anticipate before, during, and after your procedure.

What procedures can be performed during an ERCP?

Some of the treatments commonly conducted during the course of the ERCP process include:

  • Stent placement (pancreatic and biliary ducts)
  • Tissues sampling (biopsies)
  • Removal of stones (within the bile duct)
  • Biliary sphincterotomy
How might you prepare for an ERCP?

Our Washington digestive health team will provide instructions on how best to prepare for an ERCP. However, a few instructions you'll most likely be advised to follow include:

  • Do not drink or eat for eight hours before your procedure. (Water may be fine to drink. Consult your provider for confirmation.)
  • Avoid smoking for eight hours prior to your appointment.
  • Give your doctor a list of any medications you take along with any allergies you may have.

At Washington Gastroenterology, our GI specialists frequently provide endoscopic retrograde cholangiopancreatography (ERCP) for Washington patients. For more information on your options for gastrointestinal care, please call a local practice in your community today.

The staff and healthcare professionals at WAGI are compassionate, friendly and warm. I was really nervous before my procedure, but Dr. Leung and his staff helped me relax and feel safe and comfortable. I highly recommend WAGI !

D.N. Google

Staff Very professional, Friendly, keep you informed throughout the whole process.

R.R. Google

Dr. Yee was efficient, answered all of my questions, and ensured someone followed up with me after my procedure. Procedure room staff were friendly and explained their roles and activities as they performed them.

S.M. Google

My husband had a colonoscopy there. Very efficient office and surgical staff . Recommend them.

P.E. Google

Very capable, knowledgeable, and professional doctor.

L.G. Google

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