Endoscopic Retrograde Cholangiopancreatography (ERCP) in Florida
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What is an ERCP?
Gastroenterology Associates of Florida carries out endoscopic tests to assess a number of gastrointestinal disorders. An endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure where a flexible, slender "scope" or tube is positioned into the oral cavity and gently advanced to the first portion of the small intestine, known as the duodenum. The scope houses a light and a camera on the end of it which permits the practitioner to assess the inner lining of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An ERCP assessment may be completed to detect the reason for gastrointestinal symptoms, including:
- Abnormal x-ray results
- Abdominal pain
- Abnormal liver test
Please reach out to our Florida location today to arrange for a visit with a gastroenterology specialist to learn further details surrounding an ERCP procedure.
What are the benefits of an ERCP?
An ERCP may be recommended if blood tests reveal abnormal liver results, if you have pancreatic inflammation, or if you notice issues such as abdominal pain or yellowing of the skin and eyes. Some of the benefits of an ERCP procedure include:
- Efficiency: The ability to diagnose and treat a health concern within one procedure commonly reduces the overall treatment time for patients.
- Diagnostic and therapeutic: An ERCP serves multiple purposes, helping GI providers identify conditions or diseases and conduct treatment within the same process. As such, this can decrease the need for multiple interventions.
- Enhanced precision: An ERCP allows for the precise treatment and visualization of the biliary and pancreatic ducts. This is crucial for accurate diagnosis and treatment of a condition.
- Reduced recovery periods: Individuals often have expedited recovery times with an ERCP as opposed to traditional surgical approaches, facilitating a quicker return to daily activities.
What should I expect the day before my ERCP procedure?
Prior to your scheduled ERCP procedure in one of our Florida locations, you will receive specific instructions from your physician at Gastroenterology Associates of Florida concerning what to expect and how to prepare. Most patients will be allowed to eat as you normally do the day leading up to the test. Patients will be advised not to consume anything by mouth after midnight with the exception of any medications. It is very important to adhere to the information and instructions administered by your physician. Additional information concerning your medications may be given. In most circumstances, your medications will be continued as usual. However, in certain instances, especially in people on blood thinners, (for example anti-inflammatories, aspirin, Coumadin®, Plavix®, and warfarin) and with diabetic patients, special instructions will be given.
What happens the day of the ERCP exam?
You will need to enter the endoscopy center in Florida 1 – 1.5 hours prior to your procedure. This will provide you with time to complete patient forms and prepare for the assessment. You will be asked to change into a medical gown. An intravenous (IV) catheter will be placed in your arm in order for sedation to be administered. Special equipment will also be used that will allow the doctor and staff to monitor your breathing, oxygen, pulse, blood pressure, heart rate, and electrocardiogram levels during and after the exam.
When you enter the treatment room at Gastroenterology Associates of Florida, you will lie on your stomach on the stretcher. The sedation will then be given. A small dose will be given at a time to help make certain that you do not have any reaction to the sedative solution and to provide only the dosage you require individually. When compared to other endoscopic tests, it is not atypical for general anesthesia to be administered for an ERCP exam. Once a sufficient sedation level is established, the endoscope will be introduced into the mouth. The flexible scope will be gently advanced through the esophagus, stomach, and small intestine to where the pancreatic duct and bile duct open into the small bowel. A small amount of air is administered through the scope into the GI system to aid in visibility. During the ERCP procedure, radiographic contrast dye is injected into the biliary and pancreatic ducts. An x-ray machine is used to capture images of these structures to see if there are any concerns or abnormalities. Any fluid remaining in the upper gastrointestinal structures can be eliminated by way of the scope. Depending on the findings of the exam, a range of things can be conducted during the test, including biopsies, sphincterotomy (opening the bile duct or pancreatic duct), removal of gallstones from the bile ducts or stones from the pancreatic ducts, or placement of stents (plastic/metal tubes) into the bile duct or pancreatic duct. At the end of the ERCP, as much of the air and residual fluid as possible will be extracted by way of the scope. On average, the assessment takes about 30 – 90 minutes based on the results.
After the evaluation is finished, you will be moved to the recovery area to be evaluated while the sedation starts to fade away. The extent of sedation administered throughout the exam and your body's response to the medication will dictate how soon you wake up. Most patients are awake enough for release within 45 – 60 minutes. You will not be able to operate any vehicles for the rest of the day; therefore, you should plan to have a friend or relative take you home. You will also be instructed not to sign important papers, engage in strenuous activity, or work for the rest of the day. In most instances, individuals can consume foods and beverages as normal after discharge from the endoscopy unit, however, important instructions involving activity, eating, and medications will be discussed prior to dismissal. On occasion, patients will need an overnight hospital stay for evaluation or monitoring.
When can I expect my ERCP results?
Once the ERCP in Florida is complete, the GI provider and/or nursing staff will review the results of the assessment with you. The majority of patients do not recall what is discussed following the ERCP procedure because of sedative effects. Our Gastroenterology Associates of Florida team advises you to have someone accompany you to whom the outcomes can also be provided, when possible. You will also be provided with a typed synopsis and will be contacted with any biopsy or other test results typically within seven days.
What are the risks of an ERCP?
In general, ERCP is known to be a very safe evaluation. Before the procedure, a consent form will be signed and procedure risks will be explained. The risks of undergoing an ERCP can include the following:
Acute pancreatitis is the most widespread complication. This may arise in 5 – 8 percent of patients and can rise to 20 percent in certain patients.
Symptoms of pancreatitis may include nausea, vomiting, pain in the abdominal area, and fever. Most cases of pancreatitis are mild and require a hospital stay of four days or less. While hospitalized, patients often require nausea, pain control, and IV fluids. Rarely, however, pancreatitis can be more concerning and even life-threatening.
Adverse medication reactions associated with sedation can arise.
Such reactions can include breathing difficulties, allergic reactions, irritation of the vein used to give the medication, and effects on the blood pressure and heart.
Bleeding may be a result of a sphincterotomy or biopsy procedures. Major bleeding, that requires a blood transfusion or a hospital visit, is not common.
Puncturing or perforation of the esophagus, stomach, or small intestine can occur.
In most situations, a perforation of this type will result in hospitalization and surgery. This is still a very uncommon complication, even in the event where biopsies are completed or a sphincterotomy is conducted.
For 5 – 10 percent of individuals, the procedure might not be able to be carried out for varying reasons. It is highly essential that the patient get in touch with the doctor’s office immediately if any symptoms become noticeable following the procedure, such as bleeding, increasing abdominal pain, or fever.
Similar to any other exam, ERCP is not flawless. There exists a slight, understood risk that health concerns, including cancers, may not be noticed at the time of the procedure. It is essential to continually follow up with your doctors as advised and inform them of any ongoing or new issues or symptoms.
If you need an ERCP in Florida, our GI providers at Gastroenterology Associates of Florida can help you select the optimal solution for your needs.
What are alternatives to an ERCP?
To some extent, the alternative options to endoscopic retrograde cholangiopancreatography in Florida will be dependent upon the underlying reason for needing an endoscopic retrograde cholangiopancreatography. In the majority of cases, ERCP is the best approach to assess and treat certain problems in the pancreatic and biliary structures. However, an x-ray image called a magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) or echo-endoscopy can also evaluate the bile ducts and pancreatic ducts. The MRCP is only used for diagnostics. Treatment of issues will need to be accomplished through an ERCP procedure or a surgical procedure at Gastroenterology Associates of Florida. Furthermore, percutaneous transhepatic cholangiogram or endoscopic ultrasound do have treatment alternatives.
What are some questions to ask my gastroenterologist about the ERCP procedure?
If an ERCP is recommended by your GI provider, you will probably have many questions or concerns and may not know where to start. Some common questions to ask your GI specialist include:
- What might your GI provider expect to find during this procedure?
- What is the overall success rate of an ERCP?
- If a complication should arise, are there any symptoms or signs you might notice?
What should you avoid after undergoing an ERCP?
You should not drive for 24 hours after undergoing an ERCP procedure because the sedative medication may still be in your body. As a result, we ask that you have a friend or relative drive you home from your procedure. Our team might instruct you to hold off on eating for a while, depending on what form of treatment is conducted during your ERCP. Our team may also recommend taking the remainder of the day, and possibly the next day, off work so you can recover. Your Gastroenterology Associates of Florida team will provide information on what to anticipate before, during, and after your ERCP procedure.
What procedures can be performed during an ERCP?
An ERCP allows gastroenterologists to perform a variety of treatments. Some of the treatments commonly performed during an ERCP are:
- Stent placement
- Tissue sampling (biopsies)
- Stone removal (bilestones)
- Biliary sphincterotomy
How can I prepare for an ERCP?
Our Florida digestive health team will provide information on preparing for an ERCP. However, a few things you may be advised to follow are:
- Do not eat or drink for eight hours before your procedure. (Water may be okay to drink. Check with your physician for confirmation.)
- Avoid smoking for eight hours before your procedure.
- Provide your GI specialist with a list of all medications you take and any allergies you may have.
Expert care for endoscopic services
At Gastroenterology Associates of Florida, our team of highly trained GI physicians frequently conducts endoscopic retrograde cholangiopancreatography (ERCP) for Florida patients. For more information on the gastrointestinal services available to you, please get in touch with any of our Florida locations today.
Excellent staff. Superb doctor. Actually answers questions if you leave on his service.
a great kind and caring doctor and staff definitely feel heard😊
The best, friendly, explains the procedures, very special staff, made me feel comfortable, thank you Thank you 🙏🙌
Dr. Steinberg is thorough, very knowledgeable, well trained, and a nice guy. He won't rush you and he knows his stuff. Neil Berliner, M.D.
Dr. Hurwitz was the 3rd GI doctor I’ve seen & he was the first to show me compassion. He took his time to listen to me & review my medical records, from the previous doctors, with me. He asked me questions & took notes as I spoke. He made eye contact - unfortunately this is rare these days with doctors. For the first time I felt heard & cared for. He was honest & treated me like a human being - not just another dollar sign to rack up my insurance. I live an hour south of Dr. Hurwitz’s office & he was well worth the drive. If you need a GI that shows you compassion & takes time to listen to you - go see Dr. Hurwitz in Wellington!