ERCP Prep

ERCP Prep Explained

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized endoscopic procedure that uses a flexible scope and imaging to evaluate the bile ducts, gallbladder, and pancreas. Because the procedure is performed with sedation, careful preparation helps support safety and accurate results.

Important Things to Know

Continue all aspirin and anti-inflammatory medications including ibuprofen, Motrin, Aleve, naproxen, Naprosyn, sulindac, piroxicam, Feldene, indomethacin, diclofenac, and Voltaren. Tylenol (acetaminophen) is also safe to continue.
If you take a prescribed blood thinner you will need holding instructions from our office.
Arrange to have a driver take you home after the procedure. You will not be allowed to drive after receiving sedation.
If you have diabetes or are taking medications for weight loss, use the following instructions:
- Fasting (going without food) is required for this procedure, monitor your blood sugar and follow these directions
  - GLP-1 - STOP 7 days prior to your procedure. (ex: Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity, Semaglutide, Tirzepatide)
  - SGLT2 - Stop 3 days prior to procedure. (ex: Jardiance, Farxiga, Invokana, Steglatro, Brenzavvy, Glyxambi, Synjardy, Xigduo, Qtern)
  - Other oral diabetic medication: do not take the morning of your procedure.
  - Insulin Pump: Leave on, if you have questions refer to your endocrinologist.
  - Long-acting Insulin: half dose the evening before procedure. Do not take the morning of your procedure.
  - Short-acting insulin: dose as necessary with blood sugar monitoring.
  - Oral diabetic medication: do not take the morning of your procedure.
  - If you are concerned about your blood sugar dropping, consider purchasing glucose tablets.

Timing & Schedule

ERCP preparation follows a structured timeline leading up to the day of your procedure. You’ll review medications in advance, follow fasting guidelines beforehand, and arrange for transportation home after the exam. Detailed instructions and exact timing are provided below.

Instructions:

Step 1.

7 Days Before Your Procedure

If applicable,

STOP GLP-1 medications 7 days prior to your procedure

Step 2.

3 Days Before Your Procedure

If applicable,

STOP SGLT2 medications 3 days prior to procedure

Step 3.

Day of Your Procedure

8 hours prior to the procedure, BEGIN A CLEAR LIQUID DIET. Do not eat any solid foods. You may consume clear fluids including juice (apple, grape, strained orange, strained lemonade), tea, coffee (no milk or creamer), soft drinks, sports drinks (Gatorade, Powerade), clear broth or bouillon, Jell-O, and popsicles.
4 hours prior to your procedure, STOP ALL LIQUIDS. This also means NO water other than to take your medications – this is very important. Drinking less than 4 hours before your procedure may result in delay or cancellation of your procedure!
Take your usual prescribed medications with small sips of water.
Dentures will be removed prior to the procedure, please DO NOT use denture adhesive.
Please bring a list of your current medications and correct dosage to your appointment.

Step 4.

After Your Procedure

NO DRIVING – Because of the sedatives that you will be given you cannot drive for the remainder of the day. You need to have a responsible driver to take you home after your procedure. If your driver wishes to discuss the results of your procedure with the doctor, please have them accompany you to your procedure and remain on site. We do not recommend Uber, Lyft, or taking a taxi – these are not acceptable forms of transportation post-sedation.
You will be sedated for your procedure. Please avoid alcohol and making legal decisions for the remainder of the day after your procedure.

Take Aways

Additional Details

Medication:

STOP GLP-1 medications 7 days prior to your procedure.
STOP SGLT2 medications 3 days prior to procedure.
Clear liquids only 8 hours prior to your exam – that means no solid food – liquids only.
PLEASE do not drink water or anything while driving to your appointment or waiting for your appointment – we need your stomach empty to safely use sedation.
You may not remember your conversation with your doctor after your procedure – we STRONGLY recommend your driver stays IN our facility to speak with the doctor after your test.

Bring all insurance cards and a photo ID with you. Please check with your insurance company regarding prior authorization.
You will be asked to arrive 2 hours prior to your procedure time. A responsible driver is required to drive you home oryour procedure will be cancelled.
You can anticipate a minimum of 4 hours from the time of your arrival until discharge.
On occasion, overnight observation may be necessary.

This summary is based on Idaho Gastroenterology’s ERCP prep instructions and is for education only. Always follow the exact written instructions provided for your ERCP and call the office if anything is unclear.