Are you afraid of ERCP? Let's talk about it simply (ERCP)

Do you also have a strange pain in the upper abdomen that has been coming for several days? Maybe your eyes are turning yellow, with symptoms similar to jaundice? At a time like this, if your doctor tells you that you need to have an "ERCP" test, you may feel a little scared when you hear that name. But it's actually not that scary. Today, we will talk about this test called ERCP clearly and simply.

What is ERCP in simple terms?

The name ERCP sounds a bit long and complicated, doesn't it? Let's break it down. ERCP is an acronym for Endoscopic Retrograde Cholangiopancreatography .

Simply put, this is a special test that looks inside our bile ducts and pancreatic ducts . Think of it like putting a camera inside these tiny tube-like parts of our bodies.

• Endoscopic: This refers to an endoscope, which means that a thin, flexible tube with a camera attached is used for this purpose.
• Retrograde: This means "backwards." In this test, a liquid (contrast dye) is injected into these vessels in the opposite direction to normal flow.
• Cholangiopancreatography: This can be broken down into two parts. "Cholangio" means bile ducts. "Pancreato" means pancreatic ducts. "Graphy" means to take pictures. That is, to take X-ray pictures of the bile ducts and pancreatic ducts.

This test uses a special dye, which makes the inside of these small ducts very visible on the X-ray. This allows the doctor to see if there is any blockage in these ducts, such as gallstones , a tumor, or scar tissue. The best part is that if a problem is found, it can be treated right away.

Why do I need to have an ERCP test?

There are several reasons why your doctor may recommend an ERCP. The most common is when they suspect a problem with your gallbladder, bile ducts, or pancreas.

Let's look at the table below to see what are the common reasons for performing an ERCP.

How should I prepare before the test?

It is very important that you prepare properly before this test. Your doctor will give you clear instructions on what to do. Generally, you should follow these instructions:

• Food and Drink: You should avoid eating, drinking (except water), or chewing gum for about 8 hours before the test. An empty stomach is essential for a safe and clear test.
• Talk about your medications: If you are taking medications for other medical conditions, such as diabetes or high blood pressure, especially blood thinners , you should definitely tell your doctor beforehand. They may ask you to stop taking those medications for a few days.
• Allergies:If you have had a previous allergy to the medication used for anesthesia or contrast dye, inform your doctor about that as well.
• Someone to drive you home: Since you will be given sedation after the test, you will not be able to drive or go home on your own. Therefore, it is essential that you have someone to drive you home.

What happens during the test?

ERCP is usually a same-day test, meaning you can go home without having to stay in the hospital. It can take about an hour or two.

1. Sedation: First, a cannula is inserted into a vein in your arm and a sedative is given to make you sleepy. This will prevent you from feeling any discomfort or pain during the test. You may not remember anything else during this time.

2. Inserting the endoscope: Next, the doctor will slowly insert the endoscope (a tube with a camera) through your mouth, down your esophagus and stomach, and into the first part of your small intestine (duodenum). All of this is done while watching on a monitor.

3. Locating the ducts: Locating the opening of the bile ducts and pancreatic ducts in the small intestine.

4. Injecting the Contrast Dye: Next, another thin tube is passed through the endoscope, and contrast dye is injected into the duct through it.

5. X-ray (Fluoroscopy): As the dye moves through the tube, it is observed using a moving X-ray video (fluoroscopy). This X-ray is very safe because the amount of radiation is very low.

6. Diagnosis and treatment: These X-ray images allow the doctor to see exactly what blockages, stones, tumors, or other problems are inside the tubes.

Cases of treatment during the examination

This is one of the biggest advantages of ERCP. If a problem is identified, small instruments can be passed through the endoscope and treated right away.

• Stone removal: Stones stuck in the bile ducts can be crushed or removed completely.
• Biopsy: If there is a suspicious tumor or tissue, a small piece of it may be taken for further testing.
• Vascular dilation: Vascular vessels that have become narrow due to scarring can be dilated.
• Stent placement: If a vessel needs to be kept open, a small mesh tube (stent) can be inserted into it.
• Sphincterotomy:A small incision can be made in the muscle where the duct opens, enlarging the opening and allowing stones or bile to pass through more easily.

What can you expect after the test?

After the test, you will need to stay in the hospital for about an hour or two until the effects of the anesthetic wear off. After that, you can go home with the person who came to take you home.

You may experience minor discomfort for a day or two, such as:

• Sore throat: The endoscope may cause a slight sore throat. This can be reduced by eating liquids and soft foods.
• Stomach filling or evacuation: During the test, air is pumped into the stomach and intestines to better visualize the inside. This may cause a slight discomfort in the stomach. This will subside after a while.
• Nausea: Some people may experience a slight feeling of nausea due to the anesthetic medication. This will gradually go away.

What are the risks of an ERCP test?

As with any medical procedure, ERCP carries a small risk. However, serious complications are rare. Complications occur in only 5% to 10% of people who have ERCP.

Some possible complications are:

• Pancreatitis: This is the most common complication. The test can cause the pancreas to swell.
• Infection: An infection can occur in the bile ducts.
• Bleeding: Minor bleeding may occur if a tissue sample is taken or an incision is made.
• Perforation: Very rarely, the endoscope can cause a hole in the wall of the esophagus, stomach, or small intestine.

What are the special symptoms that you should talk to the doctor about?

If, after going home after the test, you develop any serious symptoms other than the minor discomfort you normally experience, call your doctor immediately or go to the nearest hospital's Emergency Department (ETU).

Symptoms to watch out for:

• Severe stomach pain or bloating.
• Fever or chills.
• Frequent vomiting.
• Chest pain or difficulty breathing.
• Bleeding from the rectum or passing black, tarry stools.

If you have any of these symptoms, don't ignore them. Seek medical advice immediately.