Endoscopic Retrograde Cholangiopancreatography (ERCP) in Hattiesburg, MS

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The physicians at Hattiesburg GI Associates, PLLC carry out endoscopic processes to identify a number of digestive health disorders in patients. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic procedure in which a long, slender "scope" or tube is placed into the oral cavity and advanced to the first section of the small intestine, called the duodenum. The device is fitted with a light and a camera on the end of it, which lets the medical provider assess the lining of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An ERCP test may be carried out to diagnose the reasons for gastrointestinal concerns such as:

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

Call our Hattiesburg, MS gastrointestinal practice today to arrange for a consultation with a GI physician to learn further details about this procedure.

Prior to your ERCP, you will receive instructions from your provider at Hattiesburg GI Associates, PLLC regarding how to prepare and what to expect. In most instances, you will be able to eat your normal diet the day prior to the procedure. You will be advised not to consume anything by mouth after midnight with the exception of medications. It is crucial to adhere to the instructions provided by your physician. Further instructions regarding your medications will be provided. In general, your regimen will be continued as usual. However, in certain cases, particularly in those taking blood thinners, (e.g., warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and in diabetics, special instructions will be administered.

You will be asked to show up at our Digestive Diseases Center in Hattiesburg, MS 1 – 1.5 hours prior to your ERCP assessment. This will allow adequate time to fill out patient forms and prepare for your ERCP. You will then need to put on a medical gown. An intravenous (IV) catheter will be placed in your arm so that sedation can be provided. You will be connected to equipment to allow the doctor and staff to monitor your blood pressure, heart rate, pulse, oxygen, breathing, and electrocardiogram levels throughout the course of and after the procedure.

When you enter the exam room, you will lie on your abdomen on the table. The sedation solution will then be administered. A small dose will be provided at a time to ensure your safety and to provide only the dosage you require individually. In comparison with other endoscopic tests, it is not uncommon for general anesthesia to be used for this exam. Once the appropriate sedation level is reached, the endoscope device will be carefully introduced into the mouth. The endoscope will be gently advanced through the esophagus, stomach, and small intestine to the point in your body where the bile and pancreatic ducts empty into the small bowel. A small amount of air is injected via the endoscope into the gastrointestinal tract to increase visibility. With an ERCP procedure, an iodine-based contrast dye is injected into the bile and pancreatic ducts. An x-ray imaging machine is then used to take images of the biliary and pancreatic ducts to identify whether there are any irregularities or abnormalities. Any residual fluid in the upper GI structures can be suctioned out by way of the scope device. Depending on exam findings, several processes can be conducted during the course of the ERCP, including tissue biopsies, stent placement (metal/plastic tubes) into the bile or pancreatic ducts, sphincterotomy (opening the bile or pancreatic duct), and the removal of gallstones from the bile ducts or stones from the pancreatic ducts. Once the procedure is complete, as much of the air and residual fluid as possible will be extracted by way of the endoscope device. Each ERCP process takes about 30 – 90 minutes to perform based on the findings.

When the evaluation is over, you will be moved to the recovery area to be assessed while the sedative effects of the medication start to subside. Most individuals are alert enough to be dismissed within 45 – 60 minutes, but your experience may vary based on how much sedation was used and your body's reaction to it. You cannot operate any vehicles for the rest of the day, so you will need to arrange for a ride home in advance. You will also be directed not to sign important papers, engage in strenuous activity, or work for the rest of the day. In most situations, individuals can consume foods and beverages as usual following discharge from the endoscopy unit, though certain instructions concerning eating, activity, and medications will be administered before dismissal. On occasion, ERCP patients will need an overnight hospital stay for monitoring.

Following the ERCP procedure, the doctor and/or clinical team will review the findings of the assessment with you. Generally, individuals do not recall what is discussed following the ERCP exam as a result of sedation effects. Our Hattiesburg GI Associates, PLLC staff advises you to have someone accompany you to whom the exam findings can also be explained, if possible. You will also be released with a typed report and can expect to be informed of any biopsy or other test results generally within a week.

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Generally speaking, ERCP is regarded as a very safe evaluation. In most instances, complications are not life-threatening, but in the event a complication occurs, it might create a need for surgery and hospitalization. Before the start of the test, the nursing staff will go over a consent to treat form with you. A nurse or physician will again explain the risks to you, and you'll have the opportunity to bring up any questions or concerns you might have.

Acute pancreatitis, or inflammation of the pancreas, is the most common complication with ERCP. It may affect 5 – 8 percent of cases, but that risk can rise to 20 percent based on individual factors. Signs and symptoms of pancreatitis can include nausea, vomiting, pain in the abdominal area, and sometimes fever. Most cases of pancreatitis are mild and require hospitalization for four days or less. While in the hospital, patients usually only need nausea and pain control along with IV fluids. A small percentage of the time, however, pancreatitis can be more concerning and may even be life-threatening.

Negative reactions related to the sedation can also occur. These reactions can include (but are not limited to) difficulty breathing, effects on blood pressure and the heart, irritation of the blood vessel used to administer the sedative, and allergic reactions. Bleeding may result from a sphincterotomy or biopsy procedures. Again, significant bleeding, such as that which could necessitate a hospital visit or a blood transfusion, is highly unusual.

Perforation of the esophagus, stomach, or small intestine can result. This might be identified at some point during the test, or it might not be apparent until later in the day. In most situations, a puncture of this type will lead to surgery and hospitalization. This is not a very common complication, even in the event where biopsies are completed or a sphincterotomy is conducted.

Finally, in 5 – 10 percent of people, the ERCP exam might not be an option for varying reasons. It is highly important that the patient reach out to their physician’s office immediately in the event any form of symptoms become noticeable following the procedure, such as bleeding, increasing abdominal pain, or fever.

As with any other exam, endoscopic retrograde cholangiopancreatography is not flawless. There is a slight, accepted risk that abnormalities, including cancers, may not be detected at the time of the exam. It is crucial to continually visit your healthcare providers as advised and inform them of any persistent or new symptoms.

Should you need to have an ERCP in Hattiesburg, MS, our GI physicians can help you determine the appropriate solution for your medical needs.

To some degree, any alternatives to endoscopic retrograde cholangiopancreatography will depend on the reason for needing the test in the first place. For the majority of patients, ERCP is the ideal approach to detect and address certain problems in the pancreatic and biliary systems. However, a type of x-ray known as a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can also examine the biliary ducts and pancreatic ducts. You should be aware that magnetic resonance cholangiopancreatography is only used for diagnostics. Treating any issues will require an ERCP procedure or surgery. The percutaneous transhepatic cholangiogram or endoscopic ultrasound do come with treatment options.

ERCP is just one of the many services offered by the GI specialists at Hattiesburg GI Associates, PLLC. If you would like to learn more about scheduling an ERCP in Hattiesburg, MS, reach out to one of our local offices today. We are ready and able to help you restore and protect your gastrointestinal health.

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