Your doctor has scheduled you to have an ERCP (Endoscopic Retrograde Cholangiopancreatography), which is a diagnostic and potentially therapeutic test done with the aid of an x-ray that allows the doctor to directly examine your liver, gallbladder, pancreas, and upper digestive tract using a narrow flexible instrument called a duodenoscope. When performed by a specially trained physician, this is a safe and accurate way to determine the condition of your liver, gall bladder, pancreas, and upper digestive tract (esophagus, stomach and first part of the small intestine or duodenum).

After preparing for your ERCP by fasting, you will report to the designated area, as discussed by your physician. Because you will be given intravenous (IV) sedation, you may not drive for 24 hours after your ERCP.

Please arrange another means of transportation.

Your ERCP will be done in the x-ray department in a hospital where a nurse will explain the procedure and give you an opportunity to ask questions before signing the consent form.

An intravenous (IV) will be started prior to your ERCP so that sedation may be given prior to and during the exam to keep you comfortable.

You will be lying on your left side for this procedure and if you wear dentures they will be removed just prior to the ERCP. After you are relaxed and drowsy from the sedation, the doctor will gently insert the duodenoscope toward the back of your throat and guide it down your esophagus into your stomach and into the first part of your small intestine. When the scope is in the proper position to examine your liver, pancreas and gall bladder, small amounts of dye may be inserted through the scope so that x-rays can be taken.

You will be able to breathe normally during the exam. Periodically, a small suction tube may be placed just inside your mouth to remove saliva that may accumulate during the exam. You may feel some bloating and may have belching during the exam. This is normal, as small amounts of air are inserted through the scope into your bowel to allow your doctor to see better.

It is important for you to let the doctor or nurse know if you have discomfort so additional medication may be given to you. It is important for you to listen to any instructions given by the doctor or nurse during the exam, as they will help keep you comfortable.

Biopsies may be taken during the exam and therapies may be performed through the duodenoscope. You should not feel this.

After your ERCP additional x-rays may be taken and then you will be taken to a room where the IV will be removed and you will rest for about one half to one hour as the effects of the medication wear off.

Before you are discharged, you will be given instructions regarding problems to be aware of after the procedure, results of the exam, treatment, diet, and follow up appointments if needed.

After your ERCP, you should not expect to be uncomfortable but:

1. If your throat is irritated, you may use warm salt water gargles or lozenges for relief.
2. You may have some discomfort in the hand or arm into which the IV was inserted, as the medication may be irritating to your veins. If this persists longer than 48 hours or you have swelling or redness at the IV site, call your doctor.
3. You may have abdominal discomfort. This is most likely due to air put in during the endoscopy and should not last long.
4. If you experience these symptoms: persistent abdominal pain, abdominal bloating, rectal bleeding, fever, nausea, or vomiting - you should contact your doctor immediately.

Feel free to discuss these and other questions with the doctor or nurse before your examination. Please call us at 845-331-8222.

Because ERCP involves looking inside of the intestine, all food material must be clear of the upper intestine so that your doctor can have a clear view. If your upper intestine is not completely clean, your doctor may not be able to safely complete the examination. Your cooperation is important.

PLEASE FOLLOW THESE INSTRUCTIONS:

1. For an AM procedure, no food or drink after midnight the night before the examination.
2. For a PM procedure, no food or drink after 7am the day of the examination.
3. No aspirin or anti-inflammation medications (e.g. Advil, Motrin, Aleve) 7 days before.
4. If you are taking insulin, diabetes medication, blood pressure medication, tranquilizers, coumadin, or other blood thinners, you will receive special instructions.