Endoscopic Retrograde Cholangiopancreatography (ERCP) in Indianapolis, IN

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Indianapolis Gastroenterology and Hepatology carry out endoscopic tests to assess various types of gastrointestinal (GI) disorders in patients. An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure where a slender, flexible "scope" or tube is placed into the mouth and gently advanced to the first portion of the small intestine, known as the duodenum. The tube has a camera and a light that lets the medical provider examine the inner lining of the esophagus, stomach, small intestine, the opening to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography assessment may be recommended to diagnose the reason for GI symptoms, such as:

  • Abnormal liver test
  • Abdominal pain
  • Abnormal x-ray results
  • Pancreatitis

Contact our Indianapolis, IN facility today to schedule a consultation with a GI physician to learn further details surrounding this endoscopic procedure.

What are the benefits of an ERCP?

An ERCP procedure may be performed if blood tests show abnormal liver results, if you're experiencing pancreatic inflammation, or if you notice issues such as pain in the abdomen or yellowing of the eyes and skin. Benefits of an ERCP are:

  • Diagnostic and therapeutic: This approach can serve dual purposes, helping physicians detect conditions and provide treatment within the same process. As such, this can decrease the need for multiple treatments.
  • Short recovery times: Individuals commonly experience faster recovery times with an ERCP as opposed to conventional surgical approaches, allowing for a faster return to normal daily activities.
  • Enhanced precision: An ERCP helps facilitate the precise visualization of and treatment within the biliary and pancreatic ducts. This is vital for correct diagnosis and treatment.
  • Efficiency: The ability to identify and treat a health concern within one procedure commonly decreases the total treatment time.

Prior to your scheduled ERCP procedure, you will receive instructions from our team at Indianapolis Gastroenterology and Hepatology outlining how to prepare and what to expect. In most instances, you can eat as you normally do the day leading up to the exam. Patients will be advised not to take anything by mouth after midnight with the exception of medications. It is essential to adhere to the information and instructions given to you by your provider. Additional information concerning your medications will likely be provided. In general, your medications will be continued as usual. In certain cases, especially in patients on blood thinners, (such as Coumadin®, warfarin, Plavix®, aspirin, and anti-inflammatories) and in diabetic patients, specific instructions will be discussed.

You will be asked to enter the endoscopy center in Indianapolis, IN 1 – 1.5 hours prior to your procedure. This is to allow time to complete patient forms and get ready for the assessment. You will be asked to put on a medical gown. Our clinical team will place an intravenous (IV) line in your arm to prepare for sedation to be administered. You will be connected to equipment that will allow the physician and our team to monitor your pulse, heart rate, blood pressure, breathing oxygen, and electrocardiogram levels throughout and after the test.

When you enter the treatment room, you will then lie on your abdomen on the table. The sedation will then be given. A small amount may be administered at a time to assure that you do not have an adverse reaction to the sedation medication and to limit it to only the dosage you require on an individual basis. When compared to other endoscopic tests, it is not uncommon for general anesthesia to be used for this exam. After a sufficient sedation status is reached, the endoscope device will be gently placed into the mouth. The endoscope will be slowly moved through the esophagus and down into the stomach, and small intestine to the location where the bile duct and pancreatic duct empty into the small intestine. A small amount of air is injected through the scope into the gastrointestinal tract to help the specialist see. During an ERCP exam, contrast dye is administered into the bile and pancreatic ducts. An x-ray imaging machine is utilized to take pictures of the bile duct and pancreatic duct to see if there are any concerns or abnormalities. Residual liquid in the upper GI tract can be suctioned out by way of the scope. Depending on the findings of the exam, a range of things can be conducted at the time of the test, including tissue extraction for a biopsy, removal of gallstones from the bile ducts or stones from the pancreatic ducts, stent placement (plastic/metal tubes) into the bile duct or pancreatic duct, and sphincterotomy (opening the bile duct or pancreatic duct). When the procedure is complete, as much of the residual fluid and air as possible will be withdrawn by way of the endoscope tool. The exam takes about 30 – 90 minutes based on the results.

After the assessment is complete, you will be moved to the recovery area to be monitored while the sedation medication begins to wane. The extent of sedation used throughout the ERCP and your response to the medication will affect how quickly you wake up, though most individuals are awake enough for release within 45 – 60 minutes. You will not be able to drive any vehicles for the rest of the day and will, therefore, need to have a relative or friend drive you home. You will also be advised not to sign important papers, engage in strenuous activity, or work for the rest of the day. Most patients can consume foods and beverages normally after being dismissed from the endoscopy unit, however, key instructions concerning activity, medications, and eating will be reviewed prior to release. There may be times when ERCP patients might need to stay in the hospital overnight for monitoring or assessment.

After the exam, the physician and/or clinical staff will go over the results of the evaluation with you. The majority of patients will not recall what is discussed after the ERCP procedure because of the effects of the sedation. Our Indianapolis Gastroenterology and Hepatology team strongly suggests you bring someone with you to whom the exam findings can also be provided, if possible. You will also go home with a typed synopsis and will be contacted with any biopsy or other test results usually within a week.

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In general, endoscopic retrograde cholangiopancreatography is regarded as a very safe procedure. In most situations, complications are not life-threatening, however, should a complication occur, it could lead to the need for surgery and hospitalization. Before the start of the ERCP exam, a consent form will be discussed with the patient by the clinical staff. Treatment risks will once again be explained by the doctor before the exam starts, and any concerns or questions can be addressed.

A condition referred to as acute pancreatitis, or inflammation of the pancreas is the most widespread complication. This condition may occur in 5 – 8% of patients, though, depending on the person, the risk can be as high as 20%. Pancreatitis signs and symptoms may include nausea, vomiting, pain in the abdominal area, and possibly fever. Most cases of pancreatitis are mild and require a hospital stay of four days or less. During the hospital stay, patients generally only need nausea and pain control along with IV fluids. Rarely, however, pancreatitis can be more concerning and can even be life-threatening.

Adverse reactions related to sedation can occur. Such reactions can include allergic reactions, difficulty breathing, effects on the heart and blood pressure, and irritation of the vein used to give the medication. Bleeding can result from a sphincterotomy or biopsy procedures. Significant bleeding which might require a hospital visit or a blood transfusion is highly uncommon.

Perforation or puncture of the small bowel, stomach, or esophagus can result. Such an occurrence may not be detected at some point during the test, or it may not be apparent until a later time. The majority of the time, a perforation will lead to hospitalization and surgery. This is a rare complication, even when biopsies are completed or a sphincterotomy is conducted.

Among 5 – 10 percent of patients, the ERCP exam might not be able to be performed for various reasons. It is extremely essential that the patient call the physician’s office right away in the event symptoms are experienced following the exam, such as bleeding, increasing abdominal pain, or fever.

Similar to any other testing process, ERCP is not perfect. There is a small, recognized risk that health concerns, including cancers, go undetected during the exam. It is vital to continually follow up with your medical practitioners as recommended and make them aware of any new or persistent symptoms.

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

In certain cases, the alternatives to the ERCP procedure will be based on the reason for needing an ERCP in the first place. For most individuals, endoscopic retrograde cholangiopancreatography is the leading way to examine and treat certain issues in the biliary and pancreatic systems. However, an x-ray called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can likewise assess the bile ducts and pancreatic ducts. On a further note, the MRCP is the only diagnostic tool. Addressing any abnormalities will involve an endoscopic retrograde cholangiopancreatography or a surgical approach. Furthermore, PTC or EUS do have treatment options.

What questions might be helpful to ask your doctor about the ERCP procedure?

If you discover that you need an ERCP procedure, you will probably have many questions and may not know where to start. Questions to consider asking your doctor might include:

  • What does your physician expect to find during this process?
  • What is the typical success rate of this procedure?
  • If a complication should arise, what symptoms or signs might you notice?
What should you not do following an ERCP?

You cannot drive for 24 hours following an ERCP procedure as the anesthesia may take that long to leave your system; therefore, we ask that you have a friend or family member plan to take you home after your procedure. We may instruct you to avoid eating for a period of time depending on the form of treatment conducted during your ERCP. Our team may also recommend taking the remainder of the day and potentially the following day off work to recover. Our Indianapolis Gastroenterology and Hepatology team will provide information on what to expect before, during, and after the ERCP process.

What types of procedures might be conducted during an ERCP?

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

  1. Sphincterotomy (of the biliary sphincter)
  2. Removal of stones (within the bile duct)
  3. Tissue sampling
  4. Placement of stents

How should you prepare for an ERCP procedure?

Our Indianapolis, IN digestive health team will administer information on how to prepare for an ERCP. However, some of the instructions you may be asked to follow are:

  • Do not drink or eat for eight hours prior to your ERCP procedure. (Water may be okay to drink. Consult your doctor for confirmation.)
  • Do not smoke for eight hours prior to your ERCP appointment.
  • Give your GI provider a list of nonprescription and prescription medications you are currently taking along with any allergies you may have.

At Indianapolis Gastroenterology and Hepatology, our group of skilled gastroenterology specialists routinely conducts endoscopic retrograde cholangiopancreatography (ERCP) for Indianapolis, IN patients. To identify your options for gastrointestinal care, please call our practice today.

I appreciate so much the care I received from Drs. Roberts, Morelli and the rest of the staff at Indy Gastro. I underwent two ERCP procedures with follow up. After the second it was their concern that I needed a second opinion for my particular set of unresolved symptoms. They did not hesitate to make the referral recommendation. I appreciate their discretion in the matter.

M.J. Google


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