ERCP in Guwahati

What is ERCP?

ERCP (endoscopic retrograde cholangiopancreatography) is a procedure to treat problems of the bile duct — the tube that carries bile from the liver and gallbladder into the intestine — and the pancreatic duct.

A thin, flexible tube with a camera (an endoscope) is passed through the mouth, down the food pipe and stomach, to the first part of the small intestine, where the bile duct opens. Through this tube, a dye is injected and X-ray pictures are taken. The doctor can then:

• make a small cut at the opening of the bile duct (sphincterotomy) so stones can come out
• pull out stones with a small balloon or basket
• place a stent — a small plastic or metal tube — to keep a blocked duct open and let bile drain
• take brushings or samples from a narrowed duct

There is no cut on the skin. Most people go home within a day or two.

When is ERCP needed?

• Stones in the bile duct (common bile duct stones), which often slip out of the gallbladder and cause pain, jaundice or pancreatitis
• Infection of the bile duct (cholangitis) — fever with chills, jaundice and pain. This is an emergency and the duct must be drained quickly
• Jaundice from a blockage (read about jaundice) caused by a growth in the pancreas, bile duct or nearby organs — a stent relieves jaundice and itching, and can make surgery or chemotherapy safer
• Bile leak after gallbladder surgery or injury
• Narrowing (stricture) of the bile duct after surgery or from inflammation
• Selected problems of the pancreatic duct, such as stones or narrowing in chronic pancreatitis

Preparing for ERCP

1. Share your reports in advance. Ultrasound, MRCP, CT scan and blood tests (especially liver tests). Patients from outside Guwahati can send photos on WhatsApp so the admission can be planned in one trip.
2. Blood tests before the procedure — usually blood counts, clotting test (INR), kidney function and liver tests.
3. Blood thinners: tell us if you take aspirin, clopidogrel, ticagrelor, warfarin, apixaban, rivaroxaban, dabigatran or any similar medicine. Some need to be paused for a few days before the stone-removal cut; others are continued. Never stop a blood thinner on your own — the plan is made with your heart doctor where needed.
4. Diabetes medicines may need adjusting on the day because you will be fasting.
5. Fasting: nothing to eat for at least 6 hours before. You will be told exactly when to stop water.
6. Come with a family member who can stay with you and take you home. You must not drive for the rest of the day after sedation.

On the day

You receive sedation through a drip so you are deeply drowsy or asleep, with your breathing, oxygen and heart rate monitored throughout. You usually lie on your front or left side. The procedure typically takes 30–60 minutes, sometimes longer for difficult stones.

To lower the chance of pancreatitis, most patients are given a pain-relief suppository (diclofenac or indomethacin) and fluids through the drip — both are recommended by international guidelines. In some patients a small temporary stent is also placed in the pancreatic duct for the same reason.

After ERCP

• You are watched for a few hours. Most patients stay overnight and go home the next day.
• A sore throat, mild bloating or burping is common and settles within a day.
• You can usually start liquids after a few hours if there is no pain, then a light diet.
• Jaundice and itching take days to weeks to fade after a blockage is relieved — the liver tests are repeated to check.

Risks of ERCP

ERCP is one of the more complex endoscopic procedures, and it is important to understand the risks before agreeing to it. Figures below are from large published studies and international guidelines — the risk for you depends on your condition and what needs to be done, and will be discussed before consent.

Serious complications, including death, are rare — well under 1 in 100 — and are more likely in patients who are already very unwell.

Some patients are at higher risk of pancreatitis (for example younger women, people who have had post-ERCP pancreatitis before, or when the duct is difficult to enter). Knowing this helps plan the safest approach — and sometimes the answer is that ERCP is not needed at all.

If a stent is placed — don't miss the follow-up

Plastic stents block over time and generally need to be changed or removed within about 3 months. A forgotten stent can cause fever, jaundice and serious infection. Keep your discharge card, note the date, and message us if you are unsure when yours is due.

What about the gallbladder?

If the bile duct stones came from gallstones, ERCP clears the duct but the gallbladder still contains stones. Removal of the gallbladder (usually by keyhole surgery) is generally advised soon afterwards, as stones commonly come back otherwise. Your surgeon and gastroenterologist will plan the timing together.

Common questions

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