Endoscopic Retrograde Cholangiopancreatography (ERCP)
in Denver, CO

Before your ERCP, you will be given specific instructions from our team at Denver Digestive Health Specialists concerning what to expect and how to prepare. Most patients will be able to eat their normal diet the day before the test. Patients will be instructed not to eat or drink anything after midnight with the exception of any medications. It is very important to adhere to the instructions given by your provider. Further instructions surrounding your medications may be given. In general, your medication regimen will be followed as normal. In certain circumstances, particularly in patients on blood thinners, (for example Coumadin®, warfarin, Plavix®, aspirin, and anti-inflammatories) and with diabetic patients, special instructions will be administered.

Our staff will ask you to arrive at the endoscopy center in Denver, CO, 1 – 1.5 hours before your evaluation. This allows time to fill out patient forms and prepare for the evaluation. You will then need to change into a medical gown. An intravenous (IV) catheter will be placed in your arm so that sedation can start. Special equipment will also be used to permit the provider and our team to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen levels throughout and after the ERCP.

After entering the treatment room, you will lie on your stomach on the stretcher. Our GI specialists will then start the sedation solution. A small amount will be administered at a time to help ensure that you do not react to the sedative solution and to provide only the dosage you require. In comparison with other endoscopic evaluations, it is not uncommon for general anesthesia to be performed for an ERCP procedure. Once the necessary sedation level is established, the endoscope will be placed into the mouth. The endoscope will be gently moved through the esophagus and down into the stomach and small intestine where the pancreatic and bile duct empties into the small bowel. A small portion of air is administered via the scope into the digestive system to increase visibility. In an ERCP, an iodine-based contrast dye is introduced into the biliary duct and pancreatic duct. An x-ray imaging machine is utilized to take images of these structures to identify whether there are any irregularities. Any fluid remaining in the upper gastrointestinal tract can be removed by way of the scope. Depending on exam findings, a number of things could be conducted during the course of the assessment, including tissue extraction for a biopsy, opening the bile duct or pancreatic duct (sphincterotomy), removal of stones from the pancreatic ducts or gallstones from the bile ducts, or the placement of stents (plastic/metal tubes) into the bile or pancreatic ducts. Once the ERCP is complete, as much of the remaining fluid and air as possible will be suctioned out via the scope. The process takes between 30 – 90 minutes to complete based on the findings.

Once the test is over, you will be escorted to the recovery room to be monitored while the sedation medication begins to wear off. The dosage of sedation used during the ERCP and how you respond to the medication will affect how soon you wake up, but most patients are awake enough for release within 45 – 60 minutes. You will not be able to operate any vehicles for the rest of the day; therefore, you should arrange for a ride home in advance. You will also be directed not to sign important documents, work, or engage in strenuous activity for the rest of the day. In most situations, individuals can consume foods and beverages as usual after being dismissed from the endoscopy unit, but pertinent instructions concerning eating, activity, and medications will be administered prior to dismissal. On occasion, patients will be admitted to stay in the hospital overnight for evaluation or monitoring.

When the ERCP is complete, the provider and/or nurse will explain the assessment findings to you. The majority of individuals do not remember what is discussed after the process as a result of the effects of the sedation. Our Denver Digestive Health Specialists team strongly suggests you bring someone with you to whom the exam findings can also be explained, if possible. You will also be released with a typed report and will be contacted with any biopsy or other test results generally within seven days.

In general, ERCP is known to be a very safe evaluation. In most situations, any complications that arise are not life-threatening. Should a complication occur, it may require hospitalization and surgery. Prior to beginning the procedure, the consent for treatment form will be discussed with the patient by the nursing staff. The provider will, again, discuss procedure risks before the exam initiates, and any concerns or questions can be discussed.

A condition referred to as acute pancreatitis, or inflammation of the pancreas is the most prevalent complication. This condition may affect 5 – 8% of cases, but the risk can be up to 20% depending on the individual. Pancreatitis signs and symptoms can include nausea, vomiting, abdominal pain, and possibly fever. Most cases are not severe and require four or fewer days in the hospital. While hospitalized, patients generally only need IV fluids and pain and nausea control. Rarely, however, pancreatitis can be more serious and even life-threatening.

Medication reactions associated with sedation can occur. These can include allergic reactions, difficulty breathing, heart and blood pressure effects, and irritation of the vein used to administer the medication. Bleeding may occur with biopsy procedures or a sphincterotomy. Again, significant bleeding, which could necessitate a hospital visit or blood transfusion, is not common.

The puncturing or perforation of the esophagus, stomach, or small bowel can take place. Such an occurrence may not be identified during the test, or remain unrecognized until a later time. In most cases, perforation of this type will lead to hospitalization and surgery. However, this is still a very uncommon complication, even when biopsies are taken or a sphincterotomy is performed.

In addition, in 5 – 10% of cases, the ERCP assessment might not be able to be carried out for varying reasons. It is very critical that the patient call the physician’s office promptly in the event any symptoms arise after the test, such as fever, worsening abdominal pain, or bleeding.

Similar to any other procedure, ERCP is not flawless. There exists a minor, acknowledged risk that health concerns, including cancers, can be missed during the procedure. It is critical to continually consult your healthcare providers as advised and bring any persistent or new symptoms to their attention.

Should you find yourself needing an ERCP in Denver, CO, our gastroenterologists can help you determine the optimal approach for your needs.

In certain cases, the alternatives are based on the intital reason for an ERCP. In the majority of cases, ERCP is the top option to evaluate and address certain problems in the biliary and pancreatic systems. However, an imaging technique referred to as a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can also evaluate the bile ducts and pancreatic ducts. It is important to note that the MRCP is only a diagnostic procedure. Addressing any concerns will need to be accomplished through an endoscopic retrograde cholangiopancreatography or surgery. In addition, EUS or PTC do have treatment options.