SCHOOL OF MEDICINE

Department of Medicine

Endoscopic Retrograde Cholangiopancreatography

Procedure

ERCP procedure room

The procedure takes place in a special room that has an instant x-ray machine called a fluoroscope. Once you enter the procedure room the nurse will place small monitoring devices on your skin so that they can measure your pulse, blood pressure and blood oxygen as necessary during ERCP. Local anesthetic may be sprayed onto the back of your throat to make it numb to try and prevent you from having a gag reflex. You will then be instructed to lie down on the procedure table. The nurse will help position you onto your left side. Once situated, you will be made comfortable and covered up with a sheet and repositioned to a face down position with your head tilted to the right. You will then be prepped for an IV line so conscious sedation can begin.

The sedative will then be administered to help achieve relaxation, reduce anxiety and assist in helping the patient attain a sleep like state. The medication is titrated to the patient's response and is adjusted accordingly. A plastic guard will then be placed in your mouth to protect your teeth.

When the nurse gives the physician the go-ahead, based on your sedated state, the doctor will begin the procedure. The first step is to place the thin flexible tube (endoscope) through the mouth guard. The endoscope will not interfere with your breathing. You will then be instructed to swallow while the doctor gently moves the endoscope down your throat and into the esophagus. The tube is a half-inch in diameter and is long enough to stretch from your mouth through your stomach and into the main bile duct that enters the duodenum (the start of your small intestine).

You will likely have a feeling of pressure against your throat while the tube is in place. You may also experience a full feeling in your stomach. You will not feel the doctor doing the diagnostic maneuvers or any therapeutic treatments. Images from the tip of the endoscope are transmitted onto the television monitors and help to assist during the maneuvers.

When dye is injected into the bile and/or pancreatic duct, x-ray films are taken by the physician's command. This will indicate whether there are any blockages or other concerns. This image is also on a television monitor parallel to the endoscope image monitor. At this stage the physician can start determining what treatments, if any, should be administered. Such treatments could include sphincterotomy, stent placement, stone removal, duct dilatation, pseudocyst drainage, or nasobiliary drainage.

The ERCP procedure can take 30 to 90 minutes. At the end of the procedure the doctor will remove the endoscope without any discomfort. The contrast dye will pass out of your body naturally. Most patients sleep through the procedure and have little or no recollection of the procedure.