Endoscopic Retrograde Cholangiopancreatography (ERCP) in Northwest Arkansas

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The providers at GI Alliance of Arkansas carry out endoscopic procedures to evaluate patients for certain types of digestive health disorders. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic process where a slender, flexible tube or "scope" is placed into the mouth and gently moved to the first section of the small intestine (called the duodenum). The device is fitted with a light and a camera that permit the provider to assess the internal tissues of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography examination may be recommended to identify the source of gastrointestinal symptoms, including:

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

Reach out to our Arkansas GI physicians today to reserve an appointment with a gastroenterology specialist to learn more about an ERCP.

What are the benefits of an ERCP?

An ERCP test may be advised if you have abnormal liver results after a blood test, if you're experiencing inflammation of the pancreas, or if you have issues such as abdominal pain or yellowing of the skin and eyes. Some benefits of an ERCP include:

  • Diagnostic and therapeutic: An ERCP may serve dual objectives, helping doctors identify conditions and deliver treatment within the same procedure. As such, this can diminish the need for multiple interventions.
  • Short recovery periods: Individuals often experience faster recovery periods with an ERCP as opposed to traditional surgical approaches, facilitating an expedited return to daily activities.
  • Enhanced precision: An ERCP helps facilitate the precise visualization of and treatment within the biliary and pancreatic ducts. This is critical for precision diagnosis and treatment.
  • Efficiency: The ability to identify and treat a condition during a single procedure generally minimizes the total treatment time.

Prior to your ERCP, the team at GI Alliance of Arkansas will issue guidelines regarding preparations and what you should expect with your procedure. The majority of patients will be able to eat normally the day leading up to the exam. You will be advised not to take anything by mouth after midnight except for medications. It is essential to adhere to the instructions given by your physician. Additional instructions surrounding your medications will be provided. In most circumstances, your medication regimen will be followed as normal. However, in certain cases, especially in individuals on anti-coagulants (such as warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and in diabetic patients, unique instructions will be discussed.

Please plan to arrive at the endoscopy unit 1 – 1.5 hours before your ERCP exam. This will allow adequate time to fill out paperwork and prepare for the evaluation. You will then need to change into a medical gown. Our clinical team will place an intravenous (IV) line in your arm to allow sedation to be given. We will also connect you to equipment that will enable the physician and staff to monitor your breathing, oxygen, pulse, blood pressure, heart rate, and electrocardiogram levels throughout the course of and after the test.

Upon entering the exam room, you will be asked to lie on your abdomen on the table. Your IV sedation will then be started. To ensure your safety and limit the risk of an adverse reaction, small amounts of sedation will be administered at a time. When compared to other endoscopic tests, it is not atypical for general anesthesia to be used for an ERCP exam. When the necessary sedation level is reached, the endoscope device will be carefully inserted into the mouth. The flexible device will be gently moved through the esophagus, stomach, and small intestine to where the pancreatic and bile ducts open into the small bowel. A small portion of air is injected via the endoscope into the gastrointestinal (GI) tract to enhance visibility. During an ERCP procedure, contrast dye is injected into the biliary and pancreatic ducts. An x-ray machine is utilized to capture images of these structures to determine if there are any concerns or abnormalities. Residual liquid in the upper digestive tract can be suctioned out by way of the endoscope. Depending on the findings of the exam, several processes can be done during the course of the ERCP, such as biopsies, stent placement (metal/plastic tubes) into the bile or pancreatic ducts, sphincterotomy (opening the bile or pancreatic duct), and the removal of gallstones from the bile ducts or stones from the pancreatic ducts. Once the procedure is complete, as much of the air and remaining fluid as possible will be withdrawn via the endoscope. On average, the assessment takes around 30 – 90 minutes to perform depending on the results.

When the assessment is over, you will be moved to the post-treatment room to be monitored while the sedation medication begins to wear off. The dosage of sedation utilized throughout the ERCP procedure and your response to the medication will determine how quickly you wake up, though most people are awake enough to be released within 45 – 60 minutes. You cannot operate any vehicles for the remainder of the day and should, therefore, arrange for a ride home. You will also be instructed not to perform strenuous activities, sign important documents, or work for the remainder of the day. The majority of times, individuals can drink and eat normally after being dismissed from the endoscopy unit, but specific instructions involving medications, activity, and eating will be given prior to discharge. There may be times when patients are admitted to stay in the hospital overnight for evaluation.

Once the ERCP procedure is finished, the specialist and/or clinical team will review the results of the exam with you. Most individuals do not remember what they are told in the wake of the process because they are still recovering from the sedation effects. Our GI Alliance of Arkansas team highly recommends you bring someone with you with whom the outcomes can also be discussed, when possible. You will also go home with a typed report and will be informed of any biopsy or other test results generally within a week.

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All in all, ERCP is a very safe evaluation. The majority of possible complications that may arise are not life-threatening, but if a problem does develop, it may require hospitalization or surgery to address. Prior to the evaluation, a consent to treat form are reviewed and discussed with the patient by the clinical team. The risks will again be rediscussed by the doctor before the ERCP procedure gets underway, and any questions or concerns can be discussed.

Acute pancreatitis is the most prevalent complication of ERCP. The condition may develop in 5 – 8% of patients, although the risk may rise to as much as 20%, depending on various factors. Symptoms of pancreatitis often include abdominal pain, nausea, vomiting, and in some instances fever. Most cases of pancreatitis are mild and require a hospital stay of four days or less. While hospitalized, patients generally only require IV fluids along with pain and nausea control. In very few cases, however, pancreatitis can be more severe and even life-threatening.

Medication reactions associated with the sedation can also arise. Such reactions can involve difficulty breathing, effects on blood pressure and the heart, irritation of the vessel used to administer the sedative, and allergic reactions. Bleeding can occur with biopsy procedures or a sphincterotomy. Significant bleeding — to a degree that requires hospitalization or a blood transfusion — is highly unusual.

Piercing or perforation of the small intestine, stomach, or esophagus can occur. Such an occurrence may be detected during the exam, or it may not be apparent until a later time. The majority of the time, a puncture of this type will require hospitalization and a surgical procedure. This is still a very uncommon complication, even when biopsies are taken or a sphincterotomy is performed.

For 5 – 10% of patients, the procedure may not be an option for a variety of reasons. It is vital that the patient call the doctor's office immediately if symptoms become evident after the test, such as bleeding, fever, or increasing abdominal pain.

The same as with any other testing process, ERCP is not perfect. There is a slight, accepted risk that health issues, including cancers, may not be identified at the time of the procedure. It is essential to continue to visit your medical providers as recommended and make them aware of any ongoing or new symptoms or concerns.

Should you find yourself needing an ERCP in Arkansas, our GI specialists can help you select the appropriate options for your health.

To a certain degree, any alternative options to ERCP will depend on the underlying reason for needing the ERCP to begin with. In the majority of cases, the ERCP procedure is the best approach to detect and treat irregularities in the pancreatic and biliary systems. However, an imaging technique referred to as a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or echo-endoscopy or endoscopic ultrasound (EUS) can additionally examine the biliary ducts and pancreatic ducts. The MRCP is only used for diagnostics. Treatment of concerns will require an ERCP or surgery. The PTC or EUS do have treatment alternatives.

What questions might be helpful to ask my doctor about ERCP?

If you discover that you need an ERCP, you will probably have questions and may be unsure of where to start. Questions to consider asking your doctor might include:

  • What does your provider expect to find during this process?
  • What is the typical success rate of an ERCP?
  • If a complication should arise, are there any signs or symptoms you might notice?
What should you not do after undergoing an ERCP?

You cannot operate a vehicle for 24 hours after your ERCP procedure as the sedative medication might still be in your body; therefore, we ask that you have a relative or friend take you home. Our team might instruct you to avoid eating for a certain period of time depending on the treatment conducted during the ERCP. Our team may also advise taking the rest of the day and potentially the next day off work to recover. Your GI Alliance of Arkansas team can provide details on what to anticipate throughout the course of your ERCP procedure.

What types of procedures can be conducted during an ERCP?

Some of the treatments commonly performed during the course of an ERCP are:

  1. Sphincterotomy (of the biliary sphincter)
  2. Removal of stones (gallstones in the bile duct)
  3. Tissue sampling
  4. Stent placement (pancreatic and biliary ducts)

How might I prepare for an ERCP procedure?

Our Northwest Arkansas digestive health team can offer instructions on how best to prepare for your ERCP procedure. However, some of the instructions you may be asked to follow are:

  • Do not eat or drink for eight hours prior to your procedure. (Water may be fine to drink. Check with your doctor to confirm.)
  • Avoid smoking for eight hours prior to your procedure.
  • Give your doctor a list of all nonprescription and prescription medications you are currently taking as well as any known allergies you may have.

At GI Alliance of Arkansas, our team of gastroenterology physicians regularly performs ERCP and other diagnostic health procedures for patients. If you are interested in learning more about scheduling an ERCP in Arkansas, we can help you find a reliable provider. Don't hesitate to call one of our local offices today.

The staff was efficient, but friendly. The anesthesiologist spoke to me before the procedure. He was informative and reassuring. Dr. Moore was also informative, efficient and professional. I felt safe. After the procedure Dr. Moore explained the results, asked me if I had questions (important) and explained the next step.

C. Google

Chelsea is an amazing APRN.

R.S. Google

Very professional, curtious, and was seen in timely manner

D.B. Google

Excellent service and professionalism. Thank you so much.

G.P. Google

All employees were very friendly. The doctor listened to me and asked appropriate questions. Waiting on lab results.

P.D. Google

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