What is Endoscopic retrograde cholangiopancreatography?
During an endoscopic retrograde cholangiopancreatography, or ERCP, the gastroenterologist uses an endoscope, a long, thin, flexible tube with a light and camera at the end. It is a slightly different type of scope than the traditional upper endoscope. The scope passes through the esophagus, the stomach, and the first part of the small intestine, called the duodenum. Once the endoscope reaches the papilla (which is the opening of the common bile duct into the small intestine) the physician injects dye through the bile or pancreatic ducts, enabling X-rays to be taken. If they are present, gallstones can be removed from the bile duct at the time of the procedure. Occasionally, biopsies or sampling of the cells from this region can be performed.
To ensure a successful exam, please follow all instructions carefully!
A sigmoidoscope is used to view the inside of the rectum and lower colon. A finger-sized thick tube with a camera at the end is inserted from the rectum, and images of the inner wall of the rectum and part of the colon can be seen on the monitor. It can be used to take a biopsy of the polyp or tumor and remove some polyps. However, a colonoscopy needs to be done to view the whole colon and remove all polyps or tumors. It is fairly safe but has a small risk of bowel tear, bleeding, and infection.
A colonoscope is similar to a sigmoidoscope but is longer and is used to examine the inner wall of the whole colon. It is inserted from the rectum, and the doctor can see the images of the entire colon on the monitor. Special surgical tools can be passed through the colonoscope to take a biopsy and remove polyps. Sedation is required. There is a small risk of bowel tears, bleeding, or infection after the procedure. It’s important to note this is the only colorectal prevention strategy offered.
This is the computed tomography scan of the colon. The person is asked to lie on a table of the CT scanner, which takes cross-sectional images of the colon. It is a non-invasive technique and does not require sedation. If any abnormalities are found, a colonoscopy needs to be done to remove the polyps or tumors.
A small tube is inserted in the rectum, and barium sulfate, a white chalky liquid, and air is pumped into the colon. The barium suspension lines the outer walls of the colon. X-ray images of the colon are then taken to reveal abnormalities on the inner wall of the colon. If any abnormalities are found, a colonoscopy needs to be done to remove the polyps or tumors.
These are done with the fecal sample and are totally safe. Fecal tests may not give confirmatory results but may suggest abnormalities in the gastrointestinal tract, warranting further tests. A colonoscopy needs to be repeated if results are positive, indicating the presence of cancerous growth in the colon. There are three types of fecal tests:
- Fecal occult blood tests detect blood in the feces that is not visible to normal eyes through a chemical reaction.
- Fecal immunochemical tests detect blood through a specific immunochemical reaction of a protein in the blood and can detect hidden blood.
- Stool DNA tests look for certain abnormal DNA genes in the cells shed from cancerous outgrowth or polyps in the stool sample.
- You MUST arrange a ride for the day of your exam. If you fail to arrange acceptable transportation, your procedure will need to be rescheduled.
- If you have diabetes, ask your primary care physician or Endocrinologist for diet and medication instructions.
- If you are or may be pregnant, please discuss the risks and benefits of this procedure with your doctor.
- Please bring a list of all of your current medications, including any over-the-counter medications with you.
- If you must cancel or reschedule your appointment, please call your doctor’s office as soon as possible.
How to Get Ready for your Procedure
Seven days before your procedure:
- If you take aspirin or NSAIDS such as Advil, Motrin, Celebrex or Ibuprofen, you may continue to take them as usual unless otherwise instructed by your physician.
- If you take a blood thinner like Plavix, Pradaxa, Clopidogrel, Coumadin, Warfarin, Effient, Prasugrel or Lovenox, you must discuss this with your doctor and prescribing physician.
- If you are taking any form of iron (ferrous sulfate, ferrous gluconate), please stop this one
week or seven days prior to your procedure.
One day before your procedure:
- Stop eating all solid foods no later than midnight.
- Clear liquids are acceptable to drink.
- Do not consume any red or purple liquids or alcohol.
- Acceptable clear liquids include: water, tea, black coffee, Apple juice, Ginger ale, Sprite, 7UP, Gatorade, Powerade, Vitamin Water, Crystal Light
- DO NOT DRINK: Anything containing fruit or vegetable pulp/seeds, milk or cream, anything that is NOT clear.
On the day of your procedure:
- Stop drinking clear liquids 6 hours prior to your exam.
- You may take all your usual morning medications with 4 oz of water up to 4 hours prior to your procedure.
- Bring a list of all your current medications, including any over-the counter medications, with you to the hospital.