ERCP (Endoscopic Retrograde Cholangiopancreatography) in New Orleans, LA

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Metropolitan Gastroenterology Associates performs endoscopic processes to diagnose a range of gastrointestinal conditions. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic process where a slender, elongated "scope" or tube is inserted into the mouth and gently moved to the first section of the small intestine called the duodenum. The scope contains a light and a camera which enables the provider to view the inner lining of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography procedure may be conducted to identify the cause of GI concerns including:

  • Pancreatitis
  • Abnormal x-ray results
  • Abnormal results from a liver test
  • Pain in the abdominal area

Contact our New Orleans, LA facility today to request a consultation with a GI specialist to learn more about the ERCP procedure.

What are the benefits of an ERCP?

An ERCP procedure may be advised if blood tests reveal abnormal liver results, if you have pancreatic inflammation, or if you have symptoms such as abdominal pain or yellowing of the skin and eyes. Benefits of an ERCP test are:

  • Diagnostic and therapeutic: This approach can serve dual objectives, helping doctors diagnose diseases or conditions and perform treatment during the same procedure. As such, this can diminish the need for multiple treatment processes.
  • Reduced recovery times: Patients commonly experience quicker recovery times with an ERCP compared to conventional approaches involving surgery, enabling a quicker return to daily or routine activities.
  • Enhanced precision: An ERCP enables the direct visualization of and treatment within the pancreatic and biliary ducts. This is vital for accurate diagnosis and treatment of a condition.
  • Efficiency: The opportunity to diagnose and treat a health issue during a single procedure generally minimizes the total treatment process for patients.

Prior to your ERCP, you will be given instructions from our team at Metropolitan Gastroenterology Associates regarding what to expect and how to prepare. Most patients will be allowed to eat normally in the day leading up to the test. Patients will be instructed not to drink or eat anything after midnight except for medications. It is imperative to adhere to the directions given by your gastroenterologist. Additional information regarding your medications may be given. In most circumstances, your medications will be continued as usual. However, in certain situations, particularly in people on blood thinners, (for example warfarin, Plavix®, Coumadin®, aspirin, and anti-inflammatories) and in diabetics, specific instructions will be discussed.

Our staff will ask you to enter the endoscopy center in New Orleans, LA 1 – 1.5 hours prior to your exam. This time will be used to complete patient forms and prepare for the evaluation. You will then need to change into a medical gown. Our clinical team will place an intravenous (IV) line in your arm so that sedation can be provided. We will also utilize equipment that will permit the gastroenterologist and staff to monitor your blood pressure, heart rate, pulse, oxygen, breathing, and electrocardiogram levels throughout the ERCP and afterward.

Upon entering the exam room, you will lie down on your abdomen on the table. The sedation will then be started. Small amounts are administered at a time to ensure that you do not have an adverse reaction to the sedative solution and to provide only the amount you require individually. When compared to other variations of endoscopic assessments, it is not uncommon for general anesthesia to be given for this exam. When a sufficient sedation level is established, the endoscope device will be placed into the mouth. The flexible scope will be carefully advanced through the esophagus, stomach, and small intestine to where the pancreatic duct and bile duct empties into the small bowel. A small pocket of air is injected through the scope into the gastrointestinal tract to aid in visibility. During this procedure, contrast is injected into the bile and pancreatic ducts. An x-ray imaging machine is used to capture images of these structures to see if there are any concerns or abnormalities. The remaining liquid in the upper digestive tract can be eliminated through the endoscope. Depending on what the findings reveal, several processes can be done at the time of the assessment, including tissue extraction for a biopsy, 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. At the end of the procedure, as much of the remaining fluid and air as possible will be suctioned out through the endoscope. Each process takes between 30 – 90 minutes to perform based on the findings.

Once the exam has concluded, you will be taken to the post-treatment area to be evaluated while the sedation starts to fade away. The amount of sedation utilized throughout the ERCP exam and how you respond to the medication will dictate how quickly you awaken, though most individuals are awake enough for discharge within 45 – 60 minutes. You cannot drive for the rest of the day; therefore, you will need to have someone drive you home. You will also be directed not to work, sign important papers, or perform strenuous activities for the remainder of the day. In most instances, individuals can resume eating and drinking as normal after being dismissed from the endoscopy unit, however, specific instructions regarding activity, eating, and medications will be discussed before release. On occasion, patients will be admitted for an overnight hospital stay for monitoring.

After the ERCP procedure, the GI specialist and/or clinical staff will go over the conclusions of the procedure with you. Most often, individuals do not recall the information provided after the evaluation because of sedative effects. Our Metropolitan Gastroenterology Associates team recommends you bring someone along to whom the outcomes can also be provided, if possible. You will also be provided with a written report and will be contacted with any biopsy or other test results generally within seven days.

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An endoscopic retrograde cholangiopancreatography, in general, is a very safe process. In most instances, complications are not life-threatening, but if a complication occurs, it may require hospitalization and surgery. Before the test, a consent to treat form will be reviewed and discussed with the patient by the nursing team. Procedure risks will once again be discussed by the provider before the ERCP test starts, and any concerns or questions can be discussed.

A health concern known as acute pancreatitis, or inflammation of the pancreas, is the most prevalent complication. It may develop in 5 – 8% of patients, though, depending on the individual, the risk can be as high as 20%. Symptoms of pancreatitis can include nausea, vomiting, abdominal pain, and in some instances fever. Most cases of pancreatitis are mild and require up to four days in the hospital. During hospitalization, patients usually only need IV fluids along with pain and nausea control. In very few cases, however, pancreatitis can be more concerning and may even be life-threatening.

Medication reactions related to sedation can arise. Such reactions can include but are not limited to breathing difficulties, allergic reactions, irritation of the vein used to give the medication, and effects on the blood pressure and heart. Bleeding can result from biopsies or a sphincterotomy. Major bleeding, which might necessitate a hospital visit or a blood transfusion, is not a common occurrence.

Perforation of the esophagus, stomach, or small bowel can result. Such an occurrence may be detected during the ERCP exam or it might not be recognized until later in the day. In most instances, a perforation of this type will lead to a hospital stay and surgery. However, this is still a very uncommon complication, even when biopsies or a sphincterotomy is performed.

Finally, among 5 – 10% of people, the procedure may not be able to be completed for various reasons. It is highly essential that the patient call their provider’s office immediately if symptoms develop following the exam, such as fever, bleeding, or worsening abdominal pain.

Similar to any other test, ERCP is not perfect. There exists a slight, understood risk that abnormalities, including malignancies, can be missed during the exam. It is essential to continue to seek care from your providers as instructed and make them aware of any new or continuing symptoms.

Should you find yourself needing an ERCP in New Orleans, LA our GI specialists can help you find the optimal options for your needs.

To some degree, the alternative options to the ERCP procedure will depend on the purpose of needing the endoscopic retrograde cholangiopancreatography in the first place. In most cases, endoscopic retrograde cholangiopancreatography is the best way to detect and treat certain issues in the biliary and pancreatic systems. However, an x-ray image referred to as a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), endoscopic ultrasound (EUS), or echo-endoscopy can likewise evaluate the biliary and pancreatic ducts. The MRCP is only a diagnostic procedure and treatment of concerns will need to be accomplished through an ERCP or a surgical procedure, however, the endoscopic ultrasound or percutaneous transhepatic cholangiogram do have alternative treatment options available.

What questions might be helpful to ask your provider about the ERCP procedure?

If you discover that you require an ERCP, you will likely have many questions or concerns and may be unsure of where to begin. Questions to consider asking your gastrointestinal doctor might include:

  • What might your physician anticipate finding during this procedure?
  • What is the typical success rate of this procedure?
  • If a complication should arise, what symptoms or signs might you notice?
What should I not do following an ERCP?

You should avoid operating a vehicle for 24 hours after your ERCP as the sedative medication might still be in your system. As a result, we ask you to have a relative or friend plan to drive you home. Our team might instruct you to avoid eating for a certain timeframe depending on the treatment performed during your ERCP. Our team may also recommend taking the rest of the day and potentially the following day off work to recover. Your Metropolitan Gastroenterology Associates team will explain what to anticipate before, during, and after the ERCP process.

What types of procedures might be conducted during an ERCP?

Treatments commonly performed during the course of the ERCP process involve:

  • Placement of stents
  • Tissue sampling
  • Stone removal (bilestones)
  • Biliary sphincterotomy
How might I prepare for an ERCP procedure?

Our New Orleans, LA gastroenterology team can give you instructions on prepping for your ERCP. However, a few instructions you'll most likely be advised to follow are:

  • Do not eat or drink for eight hours prior to your procedure. (Water may be fine. Ask your doctor for confirmation.)
  • Do not smoke for eight hours before your appointment.
  • Give your physician a list of any nonprescription and prescription medications you are currently taking as well as any known allergies you may have.

At Metropolitan Gastroenterology Associates, our team of board-certified gastroenterology specialists commonly provides endoscopic retrograde cholangiopancreatography (ERCP) for New Orleans, LA patients. To further explore the type of treatment options you have available to meet all of your gastrointestinal needs, please contact our facility today.

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Dr. Weggman is very kind. He listens attentively and takes action. I feel comfortable with him. I appreciate being able to see a doctor versus nurse practioner for serious matters. Of course, I go to them as well but for this matter i wanted the doctor.

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