Fasting Requirements for ERCP
For elective ERCP procedures, patients should fast for a minimum of 6 hours from solid foods/light meals and may consume clear liquids up to 2 hours before the procedure. 1, 2
Standard Fasting Protocol
Clear Liquids
- Clear liquids may be consumed up to 2 hours before ERCP 1, 2
- Acceptable clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea, and black coffee 1, 2
- Clear fluids empty the stomach within 60-90 minutes, making prolonged fasting unnecessary 1
Solid Foods
- Light meals (toast and clear liquids) require 6 hours of fasting 1, 2
- Fried or fatty foods require 8 hours or more of fasting due to prolonged gastric emptying 1, 2
- Both the amount and type of food must be considered when determining the appropriate fasting period 1
Non-Human Milk and Formula
- Infant formula and non-human milk require 6 hours of fasting 1, 2
- Breast milk requires only 4 hours of fasting 1, 2
Special Considerations for ERCP
High-Risk Patients Requiring Anesthesia Support
ERCP is classified as a complex endoscopic procedure that may require assistance from an anesthesia specialist for certain patient populations 1:
- ASA class IV and V patients 1
- Patients with history of adverse reactions to sedation 1
- Patients with alcohol or substance abuse history 1
- Patients with inadequate response to moderate sedation 1
Fasting Controversy in Emergency Settings
While the American College of Emergency Physicians concluded that "recent food intake is not a contraindication for administering procedural sedation and analgesia," this applies primarily to emergency department procedural sedation 1, 3. For elective ERCP, the standard ASA fasting guidelines should be followed 1, as ERCP carries specific risks including pancreatitis (1.8-4.3%), perforation (0.57-1.3%), and sepsis (3.7%) 4, 5.
Important Caveats
Patients Requiring Extended Fasting
- Patients with gastroesophageal reflux disease require longer fasting periods than standard recommendations 2
- Patients with known delayed gastric emptying need extended fasting 1, 2
- Emergency ERCP patients should follow more conservative fasting protocols 1
Risk of Aspiration
The actual incidence of clinically significant aspiration during elective procedures is low (1.4-6.0 per 100,000 anesthetics) 6, and there is no direct evidence linking fasting time to aspiration risk 1. However, the standard 2-hour clear liquid/6-hour solid food guideline provides an appropriate balance between patient comfort and safety 1.
Preoperative Carbohydrate Treatment
Patients may be given carbohydrate drinks (800 mL the night before and 400 mL two hours before the procedure) to reduce perioperative discomfort without increasing aspiration risk 1.