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From the liver to the small intestine, your digestive health plays an essential role in your overall quality of life—and survival. Gastrointestinal tract complications can range from unpleasant, such as irritable bowel syndrome, to life-threatening, such as pancreatic cancer.
Early diagnosis and treatment are key to successful recovery from most GI diseases. And endoscopic retrograde cholangiopancreatography (ERCP), an advanced, specialized procedure, can address both needs in the hands of a skilled gastroenterologist.
The goal of an ERCP is to restore the natural flow of bile, a fluid produced by the liver that helps break down fats and remove waste as you digest food. Bile is stored in the gallbladder, which empties it into the small intestine during digestion. These ducts can become blocked, narrowed, or inflamed due to gallstones, tumors, infections, scar tissue, strictures, or external compression from lymph nodes.
ERCP provides minimally invasive detection and treatment of blockages or other complications of the bile ducts, gallbladder, liver, or pancreas. To achieve this, ERCP combines two advanced technologies:
- Endoscopy: A nonsurgical procedure that provides direct visualization of your digestive tract via an endoscope (a long, flexible tube with a light and camera).
- Fluoroscopy: An imaging technique that uses X-ray technology to display real-time images and video on a screen.
Sometimes, endoscopic ultrasound can be used to gain an extra view and access to the bile and pancreatic ducts.
All surgeries carry a level of risk. Undergoing ERCP can lead to complications involving infection, bleeding, perforation, or inflammation of the pancreas (pancreatitis). However, the procedure offers a potential cure for certain GI diseases—and an alternative to invasive procedures that require longer recovery.
Because of this delicate balance between risks and benefits, ERCP should only be performed by highly experienced doctors in specific situations. MedStar Health gastroenterologists have extra training in advanced interventional endoscopy and years of expertise in performing ERCPs—we perform a high volume of these procedures yearly with an excellent success rate.
To address common concerns, I’ll discuss three questions patients often ask about the benefits and risks of ERCP.
Related reading: Gut Feelings: Insight Into Some Common Stomach Troubles
1. What are the benefits of having an ERCP?
ERCP can help us treat exactly what is causing common symptoms of a blocked bile duct. When bile ducts are blocked, bile accumulates in the liver, causing:
- Fever
- Itchy skin
- Jaundice (yellowing of the skin and eyes)
- Nausea or vomiting
- Pain in the abdomen
- Removing biliary stones through a small incision
- Taking tissue samples to evaluate for cancer cells
- Ensuring adequate bile drainage by placing a metal or plastic endoscopic stent in the bile duct
An ERCP helps patients avoid major surgery, external drains, and even abdominal scars. This is especially beneficial for patients with pancreatic cancer, which can block bile ducts. These patients are likely to undergo various therapies during their cancer treatment, and ERCPs for the correct indication can greatly improve their quality of life.
Many times, patients receiving chemotherapy who develop jaundice often need to delay chemotherapy until their jaundice is treated; ERCP can help clear it up and get them back to therapy more quickly.
Related reading: The Importance of a Healthy Liver
2. What are the risks of having an ERCP?
In approximately 3-5% of ERCP procedures, the risk of pancreatitis—inflammation of the pancreas—increases.
The bile duct opening is connected to the opening of the pancreatic duct, which transports pancreatic enzymes to the small intestine. There, the enzymes become activated to help the body digest carbohydrates, fats, and proteins.
The pancreas is located behind the stomach at the end of the bile duct. Any time we put pressure on or work around the bile duct, there is a chance of activating the pancreatic enzymes before they get to the small intestine, which can lead to inflammation – and pancreatitis. If this occurs, the pancreatitis is usually mild but can cause abdominal pain and may require pain medication or a liquid or low-fat diet for a couple days to help reduce the inflammation.
In rare cases, severe inflammation can develop and cause serious complications, which is why we are so meticulous while performing an ERCP—and why only experts specifically trained in these procedures should perform them.
Other serious but rare complications that can occur are:
- Bleeding after an incision is made to remove stones or tumors
- Infection if the ducts are not properly drained during the procedure
- Perforation of the small intestine from the endoscope.
Before every ERCP, we explain all associated risks to patients when we help them plan for what to expect before, during, and after the procedure.
Related reading: How We Diagnose and Treat Patients with Chronic Pancreatitis
3. Should I be worried about having a stent after an ERCP?
If a tumor or scar tissue has narrowed the bile duct, we might need to place a stent in the bile duct to ensure the proper drainage of fluids; this is a common practice and no cause for concern.
Some stents are temporary—for example, until the patient has surgery to remove their gallbladder due to chronic gallstones. Others are permanent, such as when pancreatic cancer cannot be removed and the tumor would continue to block the bile drainage without a stent.
Temporary stents are usually plastic and can be removed during a five-minute, painless follow-up endoscopic procedure, usually within 2-3 months after placement. Metal stents are better suited for longer periods of time.
Planning for an ERCP.
An ERCP is an outpatient procedure that lasts about an hour. You will be sedated with anesthesia, so you won’t feel any discomfort or pain and will be comfortable; many patients fall asleep during the procedure.
Because you’ll be sedated, we request that you do not eat anything after 11:59 p.m. the night before the procedure to reduce the risk of vomiting. You’ll need someone to drive you home after the ERCP because you should not operate heavy equipment for 24-48 hours after receiving anesthesia.
Before you go home, we’ll send you to a recovery room for an hour or two. We will check your blood pressure and breathing patterns to ensure you’re stable. Your throat may feel sore for a couple hours and rarely days, so you may prefer a liquid or soft-food diet until it feels better. Bloating from the procedure and mild nausea from the anesthesia happen rarely.
Liver-associated enzyme levels will start to return to normal after a week or two, and bile duct blockage symptoms will gradually subside. Jaundice can take up to three weeks to fully go away, depending on how severe it was in the first place.
ERCP is not for everyone and has very clear indications. It is an advanced endoscopic procedure with major benefits and the potential for serious complications. For certain patients, ERCP can make a significant difference in quality of life. Your success is our success; we’re here to provide expert care that can help you live more comfortably.
