Endoscopic Retrograde Cholangiopancreatography (ERCP) in Dallas, TX
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What is an ERCP?
Digestive Health Associates of Texas performs endoscopic assessments to identify a number of gastrointestinal (GI) diseases and conditions in Dallas, TX patients. An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic process where a thin, flexible tube or “scope” is placed into the mouth and advanced to the first section of the small intestine called the duodenum. The tube has a camera and a light on the end of it, which lets the GI specialist examine the inner wall of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography assessment may be needed to diagnose the cause of gastrointestinal concerns, such as:
- Abnormal x-ray results
- Abdominal pain
- Abnormal results from a liver test
Contact Digestive Health Associates of Texas today to arrange for an appointment with a gastroenterology specialist near you to learn more about an ERCP.
What should I expect the day before my ERCP procedure?
Before your ERCP, you will receive instructions from your doctor at Digestive Health Associates of Texas regarding the necessary preparation. Most patients will be allowed to eat as you normally do the day prior to the procedure; however, you will be advised not to drink or eat after midnight with the exception of medications. It is imperative to adhere to the directions administered by your doctor. Further instructions surrounding your medications will likely be given, but in most circumstances, your medication schedule will be continued as usual. In certain cases, especially in individuals on blood thinners, (such as Coumadin, warfarin, Plavix, aspirin, anti-inflammatories) and in diabetics, special instructions will be administered.
What happens the day of the ERCP?
Our staff will ask you to arrive at the endoscopy center about 1 – 1.5 hours ahead of your ERCP. This will provide you with time to fill out patient forms and get ready for the exam. You will also be asked to change into a medical gown. Our team will place an intravenous (IV) catheter in your arm to prepare for sedation. We will also connect you to equipment that will allow the physician and staff to monitor your pulse, heart rate, blood pressure, breathing oxygen, and electrocardiogram levels throughout and after the test.
Once in the treatment room, you will lie on your stomach on the stretcher. The sedation solution will then be given. A small dose will be administered at a time to assure that you do not have any reaction to the medication and to provide only the amount you require on an individual basis. In comparison with other types of endoscopic procedures, it is not unusual for general anesthesia to be given for this exam. When the appropriate level of sedation is achieved, the endoscope device will be carefully inserted into the mouth. The flexible scope will be moved through the esophagus, stomach, and small intestine to the area where the bile and pancreatic ducts empty into the small intestine. A small pocket of air is injected via the scope into the gastrointestinal (GI) system to help the physician see. During an ERCP, contrast is placed into the bile duct and the pancreatic duct. A radiographic (x-ray) imaging machine is used to take clear images of the bile duct and pancreatic duct to determine if there are any abnormalities or irregularities. Any residual fluid in the upper digestive tract can be removed via the scope. Depending on the findings of the exam, a few things might be conducted during the course of the test, including tissue extraction for a biopsy, 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. At the end of the procedure, as much of the air and remaining fluid as possible will be removed via the endoscope tool. Each ERCP process takes about 30 – 90 minutes to complete based on the findings.
When the test is finished, you will be taken to the recovery area to be evaluated while the sedative effects begin to wane. The portion of sedation utilized during the ERCP procedure and your response to it will affect how soon you wake up, although most individuals are alert enough for discharge within 45 – 60 minutes. You will not be allowed to drive any vehicles for the remainder of the day and should, therefore, have a relative or friend drive you home. You will also be instructed not to perform strenuous activities, work, or sign important documents for the remainder of the day. In most cases, individuals can consume foods and beverages normally after discharge from the endoscopy unit, although, pertinent instructions regarding eating, activity, and medications will be provided before release. On occasion, patients may need an overnight hospital stay for monitoring.
When will I get my ERCP results?
Following the ERCP procedure, the doctor and/or clinical staff will explain the findings of the procedure with you. Most often, patients will not recall the information provided after the ERCP evaluation because of the effects of the sedation. Our Digestive Health Associates of Texas staff advises you to have someone accompany you to whom the exam results can also be explained, when possible. You will also be discharged with a typed report and will be contacted with any biopsy or other test results typically within seven days.
What are the risks of an ERCP?
Endoscopic retrograde cholangiopancreatography is generally a very safe process. In most cases, any complications that develop are not life-threatening, but if a complication arises, it may require the need for surgery and/or hospitalization. Before beginning the ERCP evaluation, a consent form will be reviewed with you. Treatment risks will once again be readdressed by your GI specialist before the ERCP test gets underway, and any concerns or questions can be discussed.
A health concern known as acute pancreatitis, or inflammation of the pancreas, is the most widespread complication. This condition may impact 5 – 8% of patients, although, depending on the individual, the risk can be as high as 20%. Signs and symptoms of pancreatitis often include abdominal pain, nausea, vomiting, and possibly fever. The majority of cases are mild and require a hospital stay of four days or less. While hospitalized, patients generally only need nausea and pain control along with IV fluids. In very few cases, however, pancreatitis can be more concerning and can even be life-threatening.
Adverse reactions related to sedation can occur. These reactions can involve irritation of the vessel used to give the medication and can affect heart and blood pressure. Bleeding may occur with a sphincterotomy or biopsies. Major bleeding, such as that which might require hospitalization or a blood transfusion, is not a common occurrence.
Perforation of the small intestine, stomach, or esophagus can result. This could not be identified during the ERCP exam, or it may not be apparent until later. Most of the time, a perforation of this type will require hospitalization and a surgical procedure. It is important to note that this is a highly uncommon complication, even when biopsies or a sphincterotomy is performed.
In addition, in 5 – 10% of individuals, the endoscopic retrograde cholangiopancreatography evaluation may not be able to be conducted for a variety of reasons. It is highly imperative that you get in touch with your physician’s office promptly if any symptoms are experienced after the exam, such as increasing abdominal pain, bleeding, or fever.
As with any other procedure, ERCP is not flawless. There exists a slight, understood risk that disease, including malignancies, may not be identified with the exam. It is essential to continually follow up with your medical providers as advised and inform them of any persistent or new issues or symptoms.
If you are in need of an ERCP in Dallas, TX, our network of GI physicians can help you determine the appropriate approach for your needs.
Are there any alternatives to an ERCP?
To some degree, any alternatives to the ERCP procedure will be based on the underlying reason for needing the ERCP in the first place. For the majority of patients, the ERCP procedure is the ideal option to examine and treat certain problems in the pancreatic and biliary structures. However, an imaging technique called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can also assess the bile ducts and pancreatic ducts. On a further note, the MRCP is only used for diagnostics. Treating any concerns will need to be accomplished through an ERCP or a surgical procedure. The percutaneous transhepatic cholangiogram or endoscopic ultrasound do have treatment alternatives.
Expert care for endoscopic procedures
At Digestive Health Associates of Texas, our network of experienced GI specialists routinely performs endoscopic retrograde cholangiopancreatography (ERCP) for Dallas, TX and surrounding area patients. For more information on the services available to you, please contact our practice today.
Dr. Murray is an excellent GI doctor. He's friendly, personable, and extremely knowledgeable.
I was taken care of with great professionalism, courtesy and respect. All the staff went above and beyond to make me comfortable and attended to at all times. I asked a lot of questions and got straight forward and clear answers to all of them. I never felt rushed, and the doctor Stuart Akerman was very knowledgeable and instilled a lot of trust. I have high confidence in his treatment and skills, my experience couldn’t be better. He tells you exactly how things are and his recommendations. Very pleased.
My dad just had a colonoscopy with this doctor and wanted to give him a good review in regards to his and his staff's professionalism and attitude when answering some rather blunt questions in regards to medical concerns, overall a wonderful experience when we sit on the side of caution with my dad's post-colon cancer check-ups
Everyone was very professional kind & helpful
Dr. Sarles is a great Dr. and his staff are very friendly and helpful. I would highly recommend him and his office.