Endoscopic Retrograde Cholangiopancreatography (ERCP) in Oklahoma

Our team will ask you to arrive at the endoscopy center in Tulsa, OK 1 – 1.5 hours ahead of your assessment. This time will be used to complete patient forms and prepare for your ERCP. We will have you change into a medical gown before we insert an intravenous (IV) catheter in your arm so that sedation can be provided. We will also connect you to equipment to enable the doctor and staff to monitor your heart rate, blood pressure, pulse, electrocardiogram, breathing, and oxygen levels throughout and after the exam.

After you enter the treatment room, you will be asked to lie down on your abdomen on the bed. Your IV sedation will then be administered. A small dose will be provided at a time to assure that you do not have a reaction to the sedative solution and to administer only the dosage you specifically need. When compared to other variations of endoscopic tests, it is not unusual for general anesthesia to be given for an ERCP procedure. After a sufficient level of sedation is established, the endoscope device will be inserted into the mouth. It will be gently advanced through the esophagus, stomach, and small intestine to the position where the bile and pancreatic ducts open into the small intestine. A small amount of air is injected via the endoscope into the gastrointestinal system to aid in visibility. During this procedure, an iodine-based contrast dye is administered into the biliary duct and pancreatic duct. An x-ray imaging machine is used to take clear images of the biliary and pancreatic ducts to identify whether there are any irregularities. Remaining liquid in the upper digestive tract can be removed via the scope device. Based on what the procedure reveals, a number of things could be done during the course of the procedure, including:

• Tissue biopsies
• Sphincterotomy (opening the bile duct or pancreatic duct)
• Removal of gallstones from the bile ducts or stones from the pancreatic ducts
• Placement of stents (plastic/metal tubes) into the bile duct or pancreatic duct

Once the ERCP is complete, as much of the remaining fluid and air as possible will be withdrawn via the scope. On average, the ERCP procedure takes approximately 30 – 90 minutes to complete based on your results.

Once the test is complete, you will be escorted to the post-treatment room to be monitored while the sedation medication begins to wane. The extent of sedation used during the exam and how your body responds to it will affect how fast you wake up, but most individuals are alert enough to be released within 45 – 60 minutes. You cannot operate any vehicles for the remainder of the day and will, therefore, need to have a relative or friend drive you home. You will also be instructed not to work, perform strenuous activities, or sign important papers for the rest of the day. In most instances, individuals can resume eating and drinking as normal following discharge from the endoscopy unit, but specific instructions involving eating, medications, and activity will be reviewed prior to discharge. At times, ERCP patients might be required to stay in the hospital overnight for assessment or monitoring.

After the exam, your GI doctor will discuss the conclusions of your exam with you. Most individuals do not recall the information provided after the ERCP process because of sedation effects. Our Adult Gastroenterology Associates staff advises you to bring someone with you with whom the outcomes can also be discussed, if possible. You will also be provided with a typed synopsis and will be informed of any biopsy or other test results typically within one week.

In general, ERCP is regarded as a very safe assessment. In most instances, any complications that arise are not life-threatening but, if a complication occurs, it could lead to the need for surgery and hospitalization. Before the start of your exam, a consent form will be reviewed with you by the clinical staff. Treatment risks will again be discussed before the exam begins, and any questions or concerns can be discussed.

A condition known as acute pancreatitis, or inflammation of the pancreas, is the most prevalent complication. It may affect 5 – 8% of cases, however, depending on the patient, the risk can run up to 20%. Signs and symptoms of pancreatitis often include nausea, vomiting, abdominal pain, and in some cases fever. Most cases are mild and require a hospital stay of four days or less. During hospitalization, you would likely only need pain and nausea control along with IV fluids. In very few cases, however, pancreatitis can be more serious and life-threatening.

Negative reactions from sedation can develop. These can involve breathing difficulties, allergic reactions, irritation of the vein used to give the medication, and effects on blood pressure and the heart. Bleeding may occur with biopsies or a sphincterotomy. Again, significant bleeding which may indicate a blood transfusion or hospitalization, is highly unusual.

Puncturing of the small intestine, stomach, or esophagus can occur. This could be recognized during the procedure, or it may not be recognized until later in the day. In most instances, a puncture of this type will result in a hospital stay and surgery. However, this is a highly uncommon complication, even when biopsies are taken or a sphincterotomy is performed.

In addition, in 5 – 10% of cases, the ERCP evaluation might not be able to be performed for varying reasons. It is very vital that you contact your provider immediately in the event certain symptoms become noticeable following the test, such as fever, bleeding, or worsening abdominal pain.

As with any other testing process, endoscopic retrograde cholangiopancreatography is not flawless. There is a small, accepted risk that disease, including malignancies, can be missed during the exam. It is vital to continually follow up with your medical practitioners as advised and let them know of any new or ongoing symptoms or concerns.

If you are in need of an ERCP in Tulsa, OK, our GI specialists can help you select the ideal solution for your healthcare needs.

To some degree, the alternatives to endoscopic retrograde cholangiopancreatography will be dependent upon the underlying reason for needing an ERCP to begin with. For most individuals, ERCP is the ideal option to examine and treat abnormalities in the pancreatic and biliary systems. However, a type of x-ray called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or echo-endoscopy or endoscopic ultrasound (EUS) can additionally assess the bile ducts and pancreatic ducts. On a further note, the magnetic resonance cholangiopancreatography is only a diagnostic procedure. Addressing any abnormalities will involve an ERCP procedure or a surgical option. Moreover, endoscopic ultrasound or percutaneous transhepatic cholangiogram do have treatment options.