The advanced endoscopic retrograde cholangiopancreatography (ERCP) is a highly specialized technique that enables a physician to pass a narrower, flexible tube, or catheter, through a wider endoscope.

Instead of using an x-ray to look for abnormalities in the bile, or liver and gallbladder, ducts and pancreatic duct, during an Advanced ERCP, a physician uses the most advanced technology available to directly visualize an area instead of viewing it indirectly by x-ray.

During the procedure, your physician passes an endoscope, or narrow, plastic tube, through your mouth, esophagus and stomach and into the duodenum, or upper part of the small intestine. After slowly injecting dye as contrast material, your physician can study the biliary, or liver and gallbladder, ducts and pancreatic duct. This procedure is used for patients who need more complex duct stone dissolution and removal.

Like ERCP, this endoscopic procedure can indicate the need for more advanced surgery to treat a complex condition. Physicians also can take biopsies, or samples of tissue, from the ducts to diagnose certain medical conditions such as cancer.

How to prepare for the procedure

  • You may have diet and/or medication restrictions the week before the exam. Please ask your physician for detailed instructions. For instance, you may not be allowed to take certain over-the-counter painkillers. Be sure to let your physician know if you take aspirin or any type of blood thinning medication.
  • You will not be allowed any food or liquids (including water) for at least six hours before the procedure.
  • Plan to take the day off from work.
  • Plan to have someone you know drive you home. Because the procedure is usually performed with intravenous sedation or monitored anesthesia (MAC), you will not be allowed to drive for 24 hours after the procedure or return to work until the next day.
  • Let your physician know about any special needs, medical conditions, allergies (such as latex) and all current medications you are taking. In some cases, your doctor may prescribe an antibiotic before the procedure.
  • The NorthShore GI Lab will try to contact you the evening before your procedure to answer any questions you may have.
  • In some cases, when patients need certain therapeutic interventions during an ERCP, they may be admitted to the hospital overnight for observation.

What to expect once you arrive for your procedure

  • Plan to arrive 30 minutes before your scheduled procedure time.
  • You may have an intravenous line placed, because the procedure usually is performed with intravenous sedation or monitored anesthesia.
  • You will be asked if there is someone available to drive you home after the procedure.
  • You will be positioned on your stomach with your head turned to the right side.
  • In most cases, the procedure takes up to one hour.

What to expect after the procedure

  • After the procedure is completed, you will recover for about 30 to 45 minutes.
  • You may experience a sore throat.
  • Once you have met the discharge criteria, your physician will discuss the preliminary findings with you and let you know if you need to undergo additional testing. You also will find out when you can resume taking your usual medications.
  • If you are not admitted to the hospital for observation, you will receive discharge instructions to take home.
  • Diet and/or medication restrictions may be given to certain patients depending on the findings of the exam.
  • After the recovery period, you can return home and usually eat right away.
  • You will not be allowed to drive for 24 hours after the procedure.
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