Endoscopic retrograde cholangiopancreatography, or ERCP, is an advanced medical procedure used to diagnose and treat problems related to the bile ducts and pancreatic ducts. This procedure has saved many lives and helped doctors resolve complex problems.
Although ERCP is a useful and necessary examination, like any medical procedure, it carries some risks and potential complications. This article is written to explain this topic in simple and patient-friendly language, so that you or a family member can be fully informed before undergoing an ERCP.
What is ERCP?
ERCP is a procedure that uses an endoscope (a thin, flexible tube with a camera and light attached). The doctor inserts it through your mouth, down the esophagus and stomach, and into the small intestine (duodenum). From there, a special contrast dye is injected into the bile and pancreatic ducts, making them clearly visible on an X-ray.
This allows the doctor to detect problems such as gallstones, infections, blockages, or tumors. Sometimes, the doctor can also treat the problem during the same procedure, such as removing stones or inserting a stent.
Why is ERCP done?
Doctors recommend ERCP when other tests such as ultrasound, MRI, or CT scans do not provide sufficient information.
This procedure is performed in the following situations:
Gallstones or blockage of the bile duct
Inflammation or infection of the bile duct
Pancreatitis
Tumors or cancer in the bile duct or pancreas
Insertion of a stent or replacement of an old stent
ERCP is a specialized procedure, usually performed by gastroenterologists (GI specialists) who have special training.
Common Risks and Complications of ERCP
Although this procedure is safe for most patients, side effects or complications can occur in some cases. The doctor will explain these risks in detail before the procedure. Let’s understand them one by one:
Pancreatitis (Inflammation of the pancreas)
The most common side effect of ERCP is pancreatitis. This problem occurs in approximately 3% to 10% of patients. This happens when the pancreatic duct becomes irritated or inflamed during the procedure.
Symptoms: Upper abdominal pain
Nausea or vomiting
Fever
Abdominal bloating
Treatment: In most cases, mild pancreatitis resolves within a few days. The doctor will keep the patient in the hospital and provide a liquid diet, pain medication, and IV fluids.
Infection: Sometimes, an infection can occur after ERCP, especially if there was a blockage in the bile duct that was not completely cleared.
Symptoms:
High fever
Chills
Abdominal pain or bloating
Prevention and Treatment: The doctor may prescribe antibiotics before or after the procedure to reduce the risk of infection. If the infection worsens, hospitalization may be necessary.
Bleeding
If a sphincterotomy is performed during ERCP—that is, the end of the bile duct is cut—the risk of bleeding may increase.
Symptoms: Blood in the stool
Blood in the vomit
Weakness or dizziness
Treatment: In most cases, the bleeding is minor and resolves within a few days. In severe cases, the doctor stops the bleeding using an endoscope.
Perforation
This is a rare but serious complication. Perforation occurs when the endoscope or instrument accidentally punctures the wall of the intestine or duct.
Symptoms: Sudden, severe abdominal pain
Fever
Abdominal swelling
Vomiting
Treatment: In mild cases, the patient is only kept under observation and given antibiotics. However, in severe cases, surgery may be required.
Allergic Reaction
Sometimes, an allergic reaction may occur to the contrast dye or sedation drugs used in the procedure.
Symptoms: Difficulty breathing
Skin rash or itching
Low blood pressure
Treatment: The doctor immediately manages the situation by administering medication or injections. Therefore, it is very important to inform your doctor before the ERCP if you have any allergies to medications.
Heart or Breathing Problems
Because the patient is sedated during this procedure, some people may experience difficulty breathing or changes in heart rate. This usually occurs in patients who are older or who have pre-existing heart or lung problems Therefore, the doctor checks the patient’s medical history beforehand to avoid any risks.
Risk Reduction Measures (How to Reduce the Risks)
If you or a family member is going to have an ERCP, these precautions can significantly reduce the risks:
- Choose an experienced GI specialist: The more experienced the doctor, the lower the likelihood of complications.
- Provide your medical history: It is essential to inform the doctor about allergies, heart disease, diabetes, and medications such as blood thinners.
- Follow all of the doctor’s preparation instructions: Such as fasting before the procedure or stopping certain medications.
- Pay attention to symptoms after the procedure: If you experience severe pain, vomiting, fever, or bleeding, go to the hospital immediately.
What to Expect After ERCP?
After the procedure, the patient is kept in a recovery room for a few hours until the effects of the sedation wear off. Mild sore throat or gas in the stomach is common and usually resolves by the next day If you experience any unusual symptoms such as fever, persistent pain, or vomiting, inform your doctor immediately.
When to Contact the Doctor Immediately?
Do not delay in contacting your doctor if you experience any of the following symptoms after ERCP:
- Severe or increasing abdominal pain
- Fever above 101°F
- Blood in vomit or stool
- Difficulty breathing
- Extreme weakness
These symptoms may indicate a complication, so seek immediate medical attention.
Conclusion
ERCP is a state-of-the-art and life-saving procedure that helps in the diagnosis and treatment of many serious bile and pancreatic diseases. Although it carries some risks, with the right doctor, proper preparation, and precautions, these complications can be significantly minimized.
Remember – information, vigilance, and timely treatment are the keys to safety. If your doctor recommends ERCP, do not hesitate to ask them all your questions and proceed only after understanding the entire procedure.
