From the Guidelines
Patients can typically resume their diet immediately after an ERCP, as early oral nutrition has been shown to be safe and beneficial in reducing hospital length of stay and postoperative complications 1. When considering resuming diet after ERCP, it's essential to prioritize the patient's individual tolerance and gastrointestinal function.
- The amount of initial oral intake should be adapted to the state of gastrointestinal function and to individual tolerance 1.
- Most patients can start with clear liquids once they are fully awake and alert following sedation, usually 1-2 hours post-procedure.
- If the patient tolerates clear liquids without nausea, vomiting, or abdominal pain, they can advance to a regular diet within a few hours after the procedure. However, the timeline may vary depending on the specific findings during the ERCP and any interventions performed.
- For patients who underwent sphincterotomy, stent placement, or other therapeutic interventions, the healthcare provider might recommend a more gradual diet progression. It's crucial to note that ERCP involves manipulation of the pancreatic and biliary ducts, which can cause temporary inflammation, and allowing the digestive system some time to recover helps minimize potential complications like post-ERCP pancreatitis 1.
- Patients should also be advised to avoid alcohol for at least 24 hours after the procedure and to stay well-hydrated. If patients experience persistent abdominal pain, bloating, nausea, vomiting, or fever after resuming their diet, they should contact their healthcare provider immediately as these could indicate complications. The benefits of early oral nutrition have been emphasized by a Cochrane Systematic Review and recent meta-analyses, which showed significant benefits with regard to postoperative recovery and infection rate 1.
From the Research
Resuming Diet after ERCP
- The decision to resume diet after ERCP (Endoscopic Retrograde Cholangiopancreatography) depends on the risk of post-ERCP pancreatitis (PEP) 2.
- A study surveyed experienced endoscopists and found that:
- 53% recommended a diet of clear liquids/NPO for patients at low risk of PEP.
- 88% recommended a diet of clear liquids/NPO for patients at medium risk of PEP.
- 96% recommended a diet of clear liquids/NPO for patients at high risk of PEP.
- The study also found that about half of the respondents allowed a low-fat or regular diet in patients at low risk of PEP 2.
- There is no direct evidence from the other studies (3,4,5,6) to support a specific diet or timing for resuming diet after ERCP, as they focus on antiemetic use for nausea and vomiting in emergency department patients.
- Therefore, the recommendation for resuming diet after ERCP is based on the risk of PEP, with most experienced endoscopists limiting diet to NPO/clear liquids after ERCP for patients at high or moderate risk of post-ERCP pancreatitis 2.