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Patient Guide to Endoscopic Retrograde Cholangiopancreatography (ERCP)

This information will help you prepare for your endoscopic retrograde cholangiopancreatography (ERCP) at Memorial Sloan Kettering Cancer Center (MSKCC).

  • Ducts are tubes in your body that carry fluids.
  • Bile ducts carry bile, a fluid the liver makes to help break down food.
  • Pancreatic ducts carry pancreatic juice, a fluid the pancreas makes to help break down food.

An ERCP is a procedure that allows your doctor to look at your bile and pancreatic ducts without doing surgery. It's done when a person's bile or pancreatic ducts may be narrowed or blocked, such as by a tumor, gallstone, swelling, or other reasons. An ERCP is done with anesthesia so that you will not feel any discomfort.

Several problems can be treated during an ERCP. If your doctor sees an abnormal growth, he or she can obtain a tissue sample, also called a biopsy, and send it for further testing. If you have a gallstone, your doctor may be able to remove it during the ERCP. If your bile duct is narrow, your doctor can put in a small tube called a stent to hold it open.

A Week Before Your Procedure

Ask about your medications

You may need to stop taking some of your medications before your procedure. We have included some common examples below:

  • If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, you may need to stop it as many as 5 days before your procedure. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®). If you take any of these medications, ask your doctor when to stop taking it.
  • If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medication what you should do the day before and the morning of your procedure.

Get a letter from your doctor, if necessary

If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.

Arrange for someone to take you home

You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.

Partners in Care (888) 735-8913

Caring People (877) 227-4649

3 Days Before Your Procedure

A few days before your procedure you will receive a telephone call from an endoscopy nurse. He or she will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which to take the morning of your procedure. Use the space below to write them down.

The Day Before Your Procedure

Time of your procedure

A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call
(212) 639-5014.

If you need to cancel your procedure for any reason please call the doctor who scheduled it for you.

Do not eat or drink anything after midnight the night before your procedure. This includes water, gum, and hard candy.

The Day of Your Procedure

Things to remember

  • Do not eat or drink anything the morning of your procedure. This includes water, gum, and hard candy.
  • Take the medications you were instructed to take the morning of your procedure with a few sips of water.
  • Do not put on any lotion, cream, powder, deodorant, make-up, or perfume.
  • Do not wear any metal objects. Remove all jewelry, including any body piercings.
  • Leave all valuables, such as credit cards and jewelry, at home.
  • If you wear contact lenses, wear your glasses instead.
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What to bring with you

  • A list of the medications you take at home.
  • Your rescue inhaler (such as albuterol for asthma), if you have one.
  • Only the money you may need for the day.
  • A case for your glasses.
  • Your Health Care Proxy form, if you have completed one.
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Where to park

Parking at Memorial Sloan Kettering is available in the garage on East 66th Street between First and York Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about ¼ block toward First Avenue, on the right (north) side of the street. A tunnel connects the garage to the hospital. There are also nearby commercial garages: 4 on East 69th Street between First and Second Avenues and 3 on East 65th Street between First and Second Avenues. For questions about pricing, call (212) 639-2338.

Where to go

Your procedure will take place in the Endoscopy Suite at the main hospital, which is located at 1275 York Avenue. Take the M elevator to the 2nd floor.

What to expect

Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having procedures on the same day.

After changing into a hospital gown, you will meet your nurse. He or she will place an intravenous (IV) catheter into a vein, usually in your hand or arm. At first you will receive fluids through the IV, but it will be used later to give you anesthesia (medication to make you sleepy). Your doctor will explain the procedure, and answer any questions you have.

When it's time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose, and a mouth guard will be placed over your teeth to protect them. You will receive anesthesia through your IV, which will make you fall asleep.

Once you are asleep, your doctor will insert an endoscope (thin, flexible tube) into your mouth and pass it slowly down your throat, into your stomach, and then into your small intestine. He or she will pass a small plastic tube through the endoscope into your bile ducts. Contrast media (dye) will be used with a special x-ray will allow your doctor to see anything abnormal. If necessary, your doctor will take a biopsy (tissue sample) remove gallstones, or place a stent.

After Your Procedure

In the recovery room

You will wake up in the recovery room. Your nurse will continue to monitor your heart, breathing, and blood pressure. Once you are fully awake, your nurse will remove your IV. If you have someone waiting with you, your nurse will explain your discharge instructions to both of you before you go home.

At home

  • You may feel soreness in your throat. This will go away in a day or 2.
  • Your doctor may give you a prescription for antibiotics. Be sure to take all of them as directed.
  • You may resume your normal activities in 24 hours after your procedure.
  • Do not drink alcoholic beverages for 24 hours after your procedure.
  • Begin eating light foods as soon as you are discharged. Work your way up to your normal diet. If your doctor wants you to limit your diet for a period of time, he or she will tell you.

Call Your Doctor If You Have:

  • A temperature of 101° F (38.3° C) or higher
  • Severe stomach pain or hardness
  • Severe nausea or vomiting
  • Vomiting of blood
  • Bloody or black bowel movements
  • Weakness, faintness, or both