Have you been told that you are going to have an ERCP procedure due to a biliary system complication?
Be reassured because these are minimally invasive common procedures I see every day in interventional radiology.
I will address the most frequently asked questions from patients who come for ERCP procedure.
For this, I rely on my experience as a diagnostic radiographer who has assisted doctors with x-ray during ERCP and stay updated by consulting medical publications dedicated to the subject.
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: July 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links. Happy reading!🙋
▶️What is an ERCP procedure in concrete terms?
ERCP is short for Endoscopic retrograde cholangiopancreatography. It is a procedure that combines upper gastrointestinal (GI) endoscopy and x-ray to treat and diagnose problems of the bile and pancreatic ducts.
A bit of anatomy.
The biliary system is made of organs and ducts that produce, store, and transport a fluid called bile which helps to digest fat.
Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum.
Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum.
Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.
Image: Endoscopic Retrograde Biliary system
All these systems carry digestive juices from the pancreases and liver to the small intestine.
If they are faced with a blockage, any narrowing or growth of a tumour. Then their function is destroyed.
▶️Why you might need an ERCP procedure.
If you have been diagnosed with problems affecting the bile and pancreatic ducts.
Usually, different tests and scans are done to establish fully if you will benefit from an ERCP procedure.
Indications that usually prompt an ERCP.
🟠Pancreatic ductal system disease treatment or tissue sampling.
🟠Suspicion for pancreatic cancer.
🟠Pancreatitis of unknown cause.
🟠Biliary stenting for strictures and leakage.
🟠Drainage of pancreatic pseudocysts.
🟠When you have unexplained abdominal pain and obstructive jaundice, when your skin or the whites of your eyes turn yellow. It can be a sign of something serious, such as liver disease.
🟠You had a CT or ultrasound scan that shows a blockage in your bile ducts or pancreatic ducts.
Possible causes of blockages are:
🟢Gallstones that form in your gallbladder and become stuck in your common bile duct.
🟢Narrowing of the bile ducts
🟢Growths or cancer of the pancreas or bile ducts
🟢Acute pancreatitis
🟢Infection
Several factors will be considered in the decision to proceed with an ERCP or not:
▶️Is ERCP a major surgery: What to expect during an ERCP procedure.
ERCP is a less invasive safe procedure than surgery. It can have some complications but in rare cases.
Before the procedure your doctor will speak to you about the risks.
During the years I have assisted doctors during these procedures I can reassure you that they are always safe and quick procedures.
You will be advised not to eat or drink for up to 8 hours before the procedure, you may also be given additional instructions on how to prepare for the procedure.
The whole procedure can take about two hours from start to finish or less.
ERCP is performed under deep sedation with propofol anaesthesia, in which you lose response to verbal stimuli.
Sedation is a medicine to make you relaxed during the procedure. It might make you sleepy (drowsy), but you will not be asleep.
You do not require tracheal intubation and continue spontaneous ventilation. By this I mean they do not put you to sleep completely.
You are also given pain medicine in your bottom (a suppository) before and at the end of the procedure. This reduces the risk of pancreatitis (inflammation of the pancreas).
ERCP is performed in a room that contains X-ray equipment. You will lie on a special table, and you may be positioned on your left side, prone (facing down), or supine (facing up).
A long, flexible, lighted tube with a camera on the end is put into your mouth. Then it is passed down your food pipe (oesophagus). The tube goes into your stomach and the first part of your small intestine (duodenum).
Image of ERCP X-ray
The image A and B shows a large calcified stone in the gallbladder, in the common bile and in the distal common bile duct: C shows the stone being taken out by an endoscopy and D shows a stent in suit.
If your problem is Bile ducts: During an ERCP, small plastic or metal tubes called stents are put into the bile ducts if they are blocked. This unblocks the bile ducts and allows bile to drain into the small intestine.
If your problem is small intestine: A stent is put into the small intestine (duodenum). This helps if you have a blockage that affects the flow of food out of your stomach.
If your problem is the pancreas: Sometimes, a stent is put into a narrowed pancreatic duct to help reduce pain or remove stones.
▶️Is ERCP painful?
I have seen patients feel a short period of discomfort or pain from some parts of the procedure which does not last long.
Although many people worry about the discomfort from the endoscopy, most people tolerate it well and feel fine afterwards.
Can you feel a stent in your bile duct?
Occasionally stents cause discomfort in the upper abdomen when they are first put in.
However, this is not common and normally gets better over a few days.
▶️Does your stomach hurt after an ERCP?
Possible side effects after ERCP procedure.
⏭️You might have discomfort when swallowing for at least 48 hours after an ERCP. This discomfort can last for several weeks, but it gets better.
⏭️If you have any bloating or tummy discomfort, this might be from the air that was put into your stomach during the procedure. This is normal and should settle within 24 hours.
If the bloating or tummy discomfort does not settle, try to release the trapped wind. You can do this by moving about and changing position.
🟡Warm drinks or peppermint might also help. Try peppermint tea or peppermint water.
🟡You can take simple painkillers, such as paracetamol, after an ERCP. Always consult your doctor for a proper dose.
▶️Why can’t you eat after ERCP?
Since the pancreas plays a role in digestion, eating after an ERCP may contribute to complications such as pancreatitis.
The recommendation time for a clear liquid diet varies. Some doctors recommend a clear liquid diet for 24 hours after the procedure. However, some doctors recommend it for 12 hours or less.
Try to avoid foods in the first days that might block the stent such as raw vegetables and harder to digest, such as salads, celery, green beans and sweetcorn, nuts and dried fruit, citrus fruits and tough or gristly meat.
If your sore throat persists, continue with soft foods and advance the texture as you feel able.
Your doctor will tell you how soon you can eat after the procedure.
▶️Can you drive home after ERCP?
For safety reasons, you can’t drive for 24 hours after ERCP, as the sedatives or anaesthesia used during the procedure needs time to wear off.
You will need to make plans for getting a ride home after ERCP.
Also, avoid heavy lifting and strenuous exercise routines for a few days.
▶️What is the recovery time after an ERCP procedure?
In the table below I summarise the usual recommended time for various stages after the procedure.
| Stage | Usual timeline from day of procedure. |
| After the procedure | The nurse takes you to a recovery area. They check your pulse and blood pressure (observations) regularly and monitor you for any complications. |
| How long does Pain last after the procedure | Discomfort when swallowing for at least 48 hours, it can also last for several weeks, but it gets better |
| Eating and drinking after the procedure | you can eat as usual when you are fully awake. It is advisable to follow a clear-liquid diet for 4 to 6 hours after the procedure. Sometimes you may not eat anything for 12 hours or more. This depends on what type of treatment you had during the ERCP. |
| How long do you stay in hospital after the procedure | 4 to 6 hours after the procedure or more if you have other complications. |
| Opening your bowel | within a few days after an uncomplicated procedure |
| Complete recovery after the procedure | It should take between a few hours to a few days to feel better after an ERCP. Generally, you should feel ready to resume your regular diet, level of activity after 1 to 3 days. |
We have come to the end of this article! I wish you a very quick recovery!.🙋
DO you have any comments or questions? Your comments are welcome!
📚Sources:
Ponchon T, Pilleul F. Diagnostic ERCP. Endoscopy. 2002 Jan;34(1):29-42. doi: 10.1055/s-2002-19397. PMID: 11778128.
Parekh PJ, Majithia R, Sikka SK, Baron TH. The “Scope” of Post-ERCP Pancreatitis. Mayo Clin Proc. 2017 Mar;92(3):434-448. doi: 10.1016/j.mayocp.2016.10.028. Epub 2017 Feb 1. PMID: 28160947.
Jacob L, Geenen JE. ERCP guide wires. Gastrointest Endosc. 1996 Jan;43(1):57-60. doi: 10.1016/s0016-5107(96)70262-6. PMID: 8903820.
Park CH, Jung JH, Hyun B, Kan HJ, Lee J, Kae SH, Jang HJ, Koh DH, Choi MH, Chung MJ, Bang S, Park SW. Safety and efficacy of early feeding based on clinical assessment at 4 hours after ERCP: a prospective randomized controlled trial. Gastrointest Endosc. 2018 Apr;87(4):1040-1049.e1. doi: 10.1016/j.gie.2017.09.021. Epub 2017 Sep 28. PMID: 28964747.
Azimaraghi O, Bilal M, Amornyotin S, Arain M, Behrends M, Berzin TM, Buxbaum JL, Choice C, Fassbender P, Sawhney MS, Sundar E, Wongtangman K, Leslie K, Eikermann M. Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography. Br J Anaesth. 2023 Jun;130(6):763-772. doi: 10.1016/j.bja.2023.03.012. Epub 2023 Apr 14. PMID: 37062671.
Davis J, Sreevastava DK, Dwivedi D, Gadgi S, Sud S, Dudeja P. A Comparison of Stress Response between Insertion of Gastro-laryngeal Tube and Endotracheal Intubation in Patients Undergoing Upper Gastrointestinal Endoscopic Procedures for Endoscopic Retrograde Cholangiopancreatography. Anesth Essays Res. 2019 Jan-Mar;13(1):13-18. [PMC free article] [PubMed]
Image: Endoscopic Retrograde Cholangiopancreatography (ERCP) – NIDDK (nih.gov)