Endoscopic Retrograde Cholangiopancreatography (ERCP) in Houston, TX

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The providers at Gastroenterology Consultants conduct various endoscopic assessments to evaluate certain types of digestive health conditions and disorders in individuals. One of these assessments is endoscopic retrograde cholangiopancreatography (ERCP), which involves a slender, flexible scope that is fed through the mouth and slowly snaked as far as the first segment of the intestine (the duodenum). The scope contains a light and a camera that enable the practitioner to examine the inner lining of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An ERCP examination may be recommended to diagnose the cause of GI issues such as:

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

Reach out to our Houston, TX office today to reserve an appointment with a GI physician to hear further details surrounding endoscopic retrograde cholangiopancreatography.

An ERCP procedure may be recommended if you have abnormal liver results after a blood test, if you're experiencing pancreatic inflammation, or if you notice symptoms such as abdominal pain or yellowing of the eyes and skin. There are several advantages to having an ERCP, including:

  • Short recovery periods: Patients commonly experience expedited recovery periods with an ERCP compared to traditional surgical approaches, enabling a quicker return to normal daily activities.
  • Enhanced precision: This approach enables the direct visualization of and treatment within the pancreatic and biliary ducts, which is essential for accurate diagnosis and treatment of a condition.
  • Efficiency: The opportunity to diagnose and treat a health issue during one procedure generally reduces the overall treatment process for patients.
  • Diagnostic and therapeutic: An ERCP can serve dual objectives, helping gastroenterologists detect conditions or diseases and conduct treatment during the same procedure. This can minimize the need to undergo multiple procedures.

Prior to your ERCP, your care team at Gastroenterology Consultants will give you directions for the steps needed to prepare for the procedure. Most patients should be able to eat a normal diet the day prior to the exam. You will be instructed not to take anything by mouth after midnight with the exception of medications. It is very important to adhere to the directions given by your doctor. Additional information surrounding your medications will be given. In general, your medication schedule will be continued as usual. However, in certain instances, especially in people taking anti-coagulants, (e.g., Coumadin®, Plavix®, warfarin, anti-inflammatories, and aspirin) and in diabetics, certain instructions will be administered.

Our staff will direct you to make sure you're at our endoscopy center in Houston, TX 1 – 1.5 hours prior to your ERCP. This will allow adequate time to complete patient forms and prepare for the evaluation. You will then need to put on a medical gown. An intravenous (IV) catheter will be started in your arm so that sedation can be administered. We will also utilize equipment that will allow the doctor and our team to monitor your breathing, oxygen, pulse, blood pressure, heart rate, and electrocardiogram levels during and after the ERCP.

After you enter the treatment room, you will then position yourself on your stomach on the table. The IV sedation will be started. To ensure your safety and that you only receive the amount you need, the sedative will be administered a little bit at a time. When compared to other variations of endoscopic evaluations, it is not uncommon for general anesthesia to be performed for this procedure. After a sufficient level of sedation is established, the endoscope device will be placed into the mouth. The device will be slowly guided forward through the esophagus and into the stomach and small intestine, stopping at the location where the bile duct and pancreatic duct empty into the small bowel. A small portion of air is administered via the scope into the gastrointestinal system to enhance visibility. In this procedure, an iodine-based contrast dye is injected into the biliary and pancreatic ducts. A radiographic (x-ray) imaging machine is utilized to take clear pictures of ducts to see if there are any abnormalities or irregularities. Any residual fluid in the upper GI structures can be removed through the scope device. Based on what the procedure reveals, several things could be conducted at the time of the evaluation, such as tissue biopsies, sphincterotomy (opening the bile duct or pancreatic duct), removal of gallstones from the bile ducts or stones from the pancreatic ducts, or placement of stents (plastic/metal tubes) into the bile duct or pancreatic duct. At the end of the ERCP, as much of the remaining fluid and air as possible will be extracted via the endoscope. Each exam takes around 30 – 90 minutes to perform, depending on the results.

When the assessment is finished, you will be escorted to the post-treatment area to be monitored while the sedative effects of the medication start to fade away. The extent of sedation given throughout the exam and your body's response to it will dictate how soon you awaken, but most patients are awake enough to be discharged within 45 – 60 minutes. You will not be able to drive for the rest of the day and should, therefore, have someone drive you home. You will also be directed not to sign important papers, engage in strenuous activity, or work for the rest of the day. The majority of times, individuals can consume foods and beverages as normal after being dismissed from the endoscopy unit, however, key instructions concerning medications, eating, and activity will be given prior to dismissal. On occasion, patients might be required an overnight hospital stay for evaluation.

When the ERCP procedure is done, your doctor and/or nurse will explain the findings of the assessment to you. Most often, patients have little recollection of what is discussed in the wake of the ERCP process as a result of sedative effects. Our Gastroenterology Consultants team strongly encourages you to bring someone with you to whom the findings can also be provided, if possible. You will also be given a typed synopsis and will be advised of any test or biopsy results generally within one week.

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Generally speaking, ERCP is widely regarded as a safe procedure. Most any complications that arise are not life-threatening, but should a complication occur, it may lead to hospitalization and surgery. Before the test, a consent for treatment form will be reviewed and discussed with the patient by the nursing team. Treatment risks will again be discussed by the physician before the procedure starts, and any questions or concerns can be addressed.

A health concern known as acute pancreatitis, or inflammation of the pancreas, is the most widespread complication. This condition may arise in 5 – 8% of cases. However, depending on the individual, the risk can run as high as 20%. Symptoms of pancreatitis can include abdominal pain, nausea, vomiting, and in some cases fever. The majority of pancreatitis cases are not severe and require hospitalization for four days or less. During the hospital stay, patients often only need pain and nausea control along with IV fluids. A small percentage of the time, however, pancreatitis can be more serious and may even be life-threatening.

Adverse reactions resulting from the sedation can occur. These can include allergic reactions, difficulty breathing, effects on the heart and blood pressure, and irritation of the vein used to give the medication. Bleeding may result from a sphincterotomy or biopsies. Major bleeding, like that which may necessitate hospitalization or a blood transfusion, is not common.

Perforation or piercing of the small bowel, stomach, or esophagus can happen. Such an event may not be recognized at the time of the exam, or it might not be recognized until a later time. The majority of the time, a perforation will lead to surgery and a hospital stay. However, this is still a very uncommon complication, even when a sphincterotomy is performed or biopsies are completed.

Finally, among 5 – 10% of cases, the assessment might not be able to be completed for various reasons. It is highly important that the patient contact the physician’s office promptly if any symptoms occur following the procedure, such as increasing abdominal pain, bleeding, or fever.

As with any other procedure, endoscopic retrograde cholangiopancreatography is not flawless. There is a minor, acknowledged risk that conditions, including malignancies, may not be detected with the exam. It is critical to continue to consult your doctors as instructed and let them know of any new or ongoing issues or symptoms.

Should you need to have an ERCP in Houston, TX, our GI doctors can help you identify the ideal approach for your medical needs.

To a large degree, any alternative options to an ERCP procedure will depend on which conditions the exam is being used to identify. In the majority of cases, ERCP is the best approach to examine and treat abnormalities in the pancreatic and biliary systems. However, a radiographic (x-ray) image called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or echo-endoscopy or endoscopic ultrasound (EUS) can likewise assess the bile and pancreatic ducts. On a further note, the magnetic resonance cholangiopancreatography is only a diagnostic exam. Treatment of abnormalities will still need to be accomplished through an ERCP or a surgical procedure. Moreover, endoscopic ultrasound or percutaneous transhepatic cholangiogram do have treatment alternatives.

What are some questions to ask your GI provider about the ERCP procedure?

If it is determined you need an ERCP, you'll likely have several questions and may not know where to begin. Some common questions to ask your GI provider may include:

  • What might your GI specialist anticipate finding during this process?
  • What is the overall success rate of an ERCP?
  • If a complication should arise, what symptoms or signs might you experience?
What should I avoid doing after having an ERCP?

You should avoid operating a vehicle for 24 hours after your ERCP procedure, as the sedative medication may still be in your system. Because of this, you need to have a relative or friend take you home. You may be instructed to avoid eating for some time, depending on what form of treatment is performed during your ERCP. Our team may also recommend that you take the remainder of the day and potentially the following day off work so you can recover. Our Gastroenterology Consultants team will discuss what to anticipate before, during, and after your ERCP procedure.

What types of procedures can be conducted during an ERCP?

A variety of procedures can be conducted by a GI provider during an ERCP. Some of the more common treatments include:

  • Stent placement in pancreatic or biliary ducts
  • Tissue sampling
  • Removal of stones within the bile duct
  • Biliary sphincterotomy
How should you prepare for an ERCP procedure?

Our Houston, TX gastroenterology team can administer information on preparing for your ERCP procedure. However, a few things you may be asked to follow include:

  • Do not eat or drink for eight hours before your ERCP procedure. (Water may be fine. Consult your GI provider for confirmation.)
  • Avoid smoking for eight hours before your appointment.
  • Be sure to give your GI specialist a list of all medications you take along with any allergies you may have.

At Gastroenterology Consultants, our board-certified gastroenterology specialists routinely conduct endoscopic retrograde cholangiopancreatography for individuals suffering from a host of GI disorders. If you are in need of an ERCP procedure in Houston, TX, we are ready to work with you. For help understanding your options for gastrointestinal care, please contact one of our offices today.

Recently I have my ERCP done with Dr. Daram. I’m doing better. He gave me enough time & explain my situation throughly.

Z.M. Google


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