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Department of Internal Medicine

Department of Internal Medicine

Advanced Diagnostic and Therapeutic Endoscopic

The Division of Gastroenterology provides a full range of advanced diagnostic and therapeutic endoscopic procedures including diagnostic and therapeutic ERCP for pancreatobiliary pathologies (papillotomy, stone extraction, stricture dilation and stenting, lithotripsy, peroral choledochoscopy and pancreatoscopy), endoscopic ultrasonography including fine needle aspiration cytology and biopsy and target therapy. Other advanced procedures including therapy for BarrettĖ‡s esophagus and early cancer including radiofrequency ablation, cyrotherapy and endoscopic mucosal resection.

Endoscopic retrograde cholangiopancreatography (ERCP) combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays. This test enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. For the procedure, you will lie on your stomach. You will be given medication to help numb the back of your throat and sedative or anesthesia to help you relax during the exam. A temporary, mild sore throat sometimes occurs after the exam. Serious risks with ERCP, however, are uncommon. One such risk is excessive bleeding, especially when electrocautery is used to open a blocked duct. In rare instances, a perforation or tear in the intestinal wall can occur. Inflammation of the pancreas also can develop. These complications may require hospitalization and, rarely, surgery. 

Patient instruction:  Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. ERCP is performed with sedation so you will not be able to return to work or to drive for 24 hours and you will need someone to drive you home. Detailed instructions will be given to you by the GI lab clerk and/or your physician. The doctor may want to check your blood for proper clotting prior to procedure. It is important to inform your doctor of any family history of bleeding problems or if you are taking medications that interfere with blood clotting (such as Coumadin) or platelet function (such as aspirin, Motrin, ibuprofen, Aleve, and other non-steroidal anti-inflammatory medications).