Endoscopic Retrograde Cholangiopancreatography (ERCP) in Arizona
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What is an ERCP?
Arizona Digestive Health conducts endoscopic assessments to evaluate a number of gastrointestinal disorders in patients. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic process where a slender, elongated "scope" or tube is positioned into the oral cavity and gently advanced to the duodenum or first portion of the small intestine. The scope is fitted with a camera and a light that lets the medical provider to assess the inner wall of the esophagus, stomach, small intestine, the opening to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography procedure may be completed to detect the cause of gastrointestinal concerns, including:
- Abdominal pain
- Abnormal x-ray results
- Abnormal liver test
Get in touch with our Phoenix, AZ practice today to request a consultation with a gastroenterologist to hear further details surrounding an ERCP procedure.
How can I prepare for my ERCP procedure?
You will be provided with specific instructions from your physician at Arizona Digestive Health detailing the necessary preparation. Most patients will be able to eat your normal diet the day prior to the test. You will be instructed not to take anything by mouth after midnight with the exception of medications. It is crucial to follow the information and instructions administered by your doctor. Additional information surrounding your medications may be given. In general, your medication schedule will be continued as usual. In certain cases, especially in people taking anti-coagulants, (such as warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and in diabetic patients, special instructions will be provided.
What happens the day of the ERCP exam?
You will need to enter at the endoscopy center in Phoenix, AZ 1 – 1.5 hours ahead of your ERCP evaluation. This will provide you with time to fill out patient forms and get ready for your ERCP. You will then need to put on a medical gown. An intravenous (IV) catheter will be placed in your arm so that sedation can be provided. We will also connect you to equipment that will allow the physician and staff to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen levels throughout and after the procedure.
Upon entering the exam room, you will lie on your stomach on the stretcher. Your IV sedation will then be started. A small dose will be provided at a time to ensure that you do not have any reaction to the sedative solution and to administer only the dosage you need on an individual basis. In comparison with other types of endoscopic tests, it is not unusual for general anesthesia to be performed for an ERCP exam. Once an adequate sedation level is achieved, the endoscope device will be gently inserted into the mouth. The flexible device will be carefully forwarded through the esophagus and into the stomach, and small intestine to the position where the pancreatic duct and bile duct open into the small bowel. A small portion of air is injected through the endoscope into the GI system to help the specialist see. During an ERCP exam, radiographic contrast dye is introduced into the bile and pancreatic ducts. An x-ray machine is utilized to take pictures of these structures to detect whether there are any abnormalities. Residual liquid in the upper digestive structures can be removed through the scope device. Depending on any discoveries, a few things can be carried out during the evaluation, such as 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. When the procedure is complete, as much of the remaining fluid and air as possible will be suctioned out through the endoscope device. In general, the ERCP evaluation takes about 30 – 90 minutes to complete based on the results.
When the evaluation is over, you will be taken to the recovery room to be assessed while the sedative effects begin to subside. The amount of sedation used during the procedure and your body's response to it will determine how quickly you wake up, though most people are awake enough for dismissal 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 rest of the day. Most patients can eat and drink normally following discharge from the endoscopy unit, although certain instructions regarding activity, medications, and eating will be provided before release. Sometimes, ERCP patients will need an overnight hospital stay for for assessment or monitoring.
When will I get my ERCP results?
After the ERCP procedure, the physician and/or nursing team will explain the conclusions of the test with you. Most individuals have little recollection of the information provided following the ERCP procedure as a result of sedative effects. Our Arizona Digestive Health team recommends you to bring someone with you to whom the ERCP findings can also be explained, when possible. You will also be given a typed report and will be contacted with any biopsy or other test results usually within one week.
What are the risks of an ERCP?
ERCP, in general, is a very safe process. In most cases, complications are not life-threatening but, in the event a complication occurs, it might require hospitalization and surgery. Before the ERCP assessment, a consent to treat form will be review with and explained to the patient by the clinical team. Treatment risks will again be discussed by the physician before the procedure gets underway, and any concerns or questions can be addressed.
A condition known as acute pancreatitis, or inflammation of the pancreas, is the most widespread complication. This may arise in 5 – 8% of patients, though, depending on the person, the risk can run as high as 20%. Symptoms of pancreatitis may include nausea, vomiting, abdominal pain, and possibly fever. Most cases are not severe and require hospitalization for four days or less. During the hospital stay, patients generally only need IV fluids along with pain and nausea control. In very few cases, however, pancreatitis can be more serious and can even be life-threatening.
Adverse reactions associated with the sedation can occur. These reactions can involve breathing difficulties, allergic reactions, irritation of the vein used to give the medication, and effects on the blood pressure and heart. Bleeding can occur with a sphincterotomy or biopsy procedures. Major bleeding, like that which may indicate a blood transfusion or a hospital visit, is very uncommon.
The puncturing or perforation of the small intestine, stomach, or esophagus can take place. Such an occurrence may not be recognized at the time of the procedure, or it might not be apparent until a later time. In most situations, a perforation will lead to surgery and a hospital stay. It is important to note that this is not a very common complication, even in the event where a sphincterotomy is performed or biopsies are completed.
In addition, in 5 – 10% of patients, the assessment may not be able to be conducted for various reasons. It is extremely essential that the patient get in touch with the doctor’s office immediately in the event any type of symptoms develop following the exam, such as bleeding, fever, or increasing abdominal pain.
As with any other exam, endoscopic retrograde cholangiopancreatography is not perfect. There is a minor, understood risk that health problems, including cancers, may not be identified during the procedure. It is vital to continually consult your healthcare providers as recommended and let them know of any persistent or new symptoms or issues.
Should you need to have an ERCP in Phoenix, AZ, our GI doctors can help you identify the optimal options for you.
What are alternatives to an ERCP?
To some degree, the alternative options to the procedure will be dependent upon the purpose for requiring the endoscopic retrograde cholangiopancreatography in the first place. In the majority of cases, endoscopic retrograde cholangiopancreatography is the top method to examine and treat certain issues in the pancreatic and biliary structures. However, a type of x-ray known as a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can additionally evaluate the bile and pancreatic ducts. It is important to note that the MRCP is only utilized for diagnostics. Treatment of concerns will need to be accomplished through an ERCP procedure or surgery. In addition, EUS or PTC do have treatment options.
Skilled care for endoscopic procedures
At Arizona Digestive Health, our team of skilled GI specialists commonly provides endoscopic retrograde cholangiopancreatography (ERCP) for Phoenix, AZ patients. To learn more about the gastrointestinal services available to you, please get in touch with our practice today.
EAST VALLEY GASTRO- Dr Panossian: The most caring physician I have seen in years. Not that the others have been bad, he is just several notches above. He is very upbeat, great bedside manner with exceptional communication. Took his time and seemed to really care to find the cause of my belly pain- even suggesting possibilities outside of his scope of practice. He's definitely one of the good ones. I'd recommend him to anyone!
Dr Panossian is a really great doctor. He answers all your questions and you never feel rushed. I feel very confident in his knowledge and care. Great bedside Manor. I wholeheartedly recommend him!!
My mom is a patient of Dr Panossian. He is wonderful, really listens, very professional and easy to talk to. I would highly recommend him to friends and co-workers.
Dr Panossian is very good at listening and letting you explain what's going on, he also tries different things to see if they will help you, he hasn't stopped trying different medications or procedures if necessary to see if they would help. He is a very good Doctor.
I have been a patient of Dr. Panossian for many years. He is the kindest man. He takes the time to listen and to answer my questions. I would recommend him to friends and family.