Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
An Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is a type of x-ray examination performed during an endoscopy procedure that enables your doctor to examine and/or treat conditions of the biliary system (liver, gallbladder, pancreas, pancreatic and bile ducts). This is the plumbing system of the liver. The most common reasons to do an ERCP are jaundice or abnormal liver blood tests, especially if you have pain in the abdomen or a scan (ultrasound or CT scan) shows stones or a blockage of the bile or pancreatic ducts.
- This procedure can help us to identify any abnormalities in the biliary system (liver, gall bladder, and pancreas).
- A biopsy (tissue sample) can be obtained during the investigation.
- Gallstones in the bile duct can be diagnosed and removed during an ERCP, usually after making a small cut at the bottom of the bile duct (called a sphincterotomy).
- Blockages of the bile duct can be treated by putting a small, hollow, plastic or metal tube (called a stent) inside the duct. This allows the bile to bypass the blockage and will relieve yellow jaundice and itching caused by the buildup of bile.
- ERCP can also be used to diagnose and treat complications from gallbladder and liver surgery or major trauma (usually leakage of bile).
ERCP is generally safe but complications can sometimes occur.
- Mild discomfort in the tummy and a sore throat, which may last for a few hours.
- Loose teeth, crowns and bridgework can rarely be dislodged.
- Irritation to the vein in which medications were given is uncommon, but may cause a tender lump lasting up to a few weeks.
- Inflammation of the pancreas. If this happens, you will have pain in the abdomen, usually starting a few hours after the procedure and lasting for a few days.
Please tell us if you have any allergies
Possible major complications:
- Severe pancreatitis (inflammation of the pancreas) can occur following an ERCP. We can treat this with medication or surgery. Although it is very rare, severe pancreatitis can be fatal (less than one in 500 cases).
- If sphincterotomy is performed, there is a risk of bleeding which usually stops quickly by itself. However, in severe cases, blood transfusion or an operation may be required to control the bleeding. This rarely can be fatal (less than one in 500).
- Very frail and/or elderly patients can get pneumonia from stomach juices getting into the lung (approximately one in 500 cases).
- A hole may be made in the wall of the duodenum (perforation), either as a result of sphincterotomy or due to a tear made by the endoscope. This happens in less than one in 750 cases. It might require surgery to put right and may occasionally be fatal.
- Infection can occur in the bile ducts but we will usually give you antibiotics to help prevent this. Rarely if there is a lot of infection in the bile duct you could develop sepsis (serious infection of the body) after the procedure. Antibiotics should limit this.
- The sedation can cause agitation, difficulty breathing (which can increase the risk of pneumonia) or respiratory arrest (though this is very rare).
- A CT scan can be performed, but the investigation is less sensitive, and small lesion or growths (less than 1cm) can be missed, and no biopsies can be obtained and no treatment can be undertaken.
- An ultrasound scan can provide ultrasonic images of the biliary system, but no biopsies can be obtained and no therapeutic intervention (treatment) can be performed.
Consent: We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of the treatment proposed, please do not hesitate to speak with a senior member of staff again.
Before the procedure starts, a nurse will attach monitors to one of your fingers to record your pulse and oxygen level. You will need lie on your left side and a mouth guard will be placed in your mouth. This enables the scope to pass through your mouth and oxygen to be administered to you throughout the examination. A long, flexible tube about the width of an index finger, with a tiny camera on the end of it (duodenoscope) will be passed through the mouth, down the gullet, into the stomach, and then into the top part of the small intestine (duodenum). Sedation ERCP will be performed with intravenous analgesic and sedation. The medicine will be given via a cannula in your hand or arm. It will relax you and may make you drowsy but will not put you to sleep. You will hear what is said to you and be able to respond to any instructions given to you. If you are very ill or the doctor has concerns, you may be given a general anaesthetic for this procedure.
The actual procedure takes about one hour. You may need to stay overnight in hospital afterwards to allow us to observe you for any late onset complications.
Valuables: Please do not bring in valuables, jewellery or large sums of money. If this is unavoidable, please ask a relative to take them home for you. If this is not possible, hand in any valuables to the nurse in charge of your ward on your arrival. They will be listed and locked in a safe and you will be given a receipt. The hospital cannot accept liability for the loss of items that are not handed in for safekeeping.
You must not eat anything or drink any milk for six hours before your examination. However, you may continue to drink clear liquids such as black tea or coffee, sugary drinks and clear soup for up to two hours before your appointment time.
If you a diabetic on insulin your blood sugar level will be closely monitored – an insulin infusion (sliding scale) will be set up in the ward before the procedure.
Do not take aspirin on the day of your procedure.
Please tell your doctor if you are taking warfarin or heparin as your blood clotting time will be checked the day before the investigation. Infusion of platelets may be required to correct the clotting time. If you are warfarin you will need to come into hospital three days before your procedure so that your warfarin can be changed to heparin.
Antibiotics will be given to you in the ward before and after the procedure. If you are allergic to any antibiotic, you must inform your doctor or any of the nursing staff.
Take all other medication as prescribed.
Your details will be taken and checked by our nursing staff, they will take your blood pressure and ask you some questions related to your health.
You will also be seen by a doctor who performs the procedure to assess you and obtain consent.
General information: Before the procedure you must remove the following as they can cause discomfort and will interfere with the instruments used:
- Contact lens
- Jewellery (including body piercing)
- False teeth (you can keep these in until immediately before the procedure)
Hearing aids can be left in-situ throughout the procedure.
- You will be transferred to the recovery area. Once your general condition is stable, you will be escorted back to the ward by your ward nurse. You will then have to stay overnight.
- Most of the time, you can eat as normal once you are fully awake. However, depending on the type of treatment you had during the procedure, you may have to fast for 12 hours or more afterwards.
- If needed you will have to stay in the ward until the next morning to allow us to observe you for any late onset complications. You will also be a little sleepy for a while after the procedure.
- Occasionally you may need to stay in hospital for other investigations and treatments.
- The effect of the sedative can last up to 36 hours so you must not drive, operate machinery or drink alcohol during that time.
- You may experience some mild stomach cramps from the air that was introduced into your stomach during the procedure. This will soon disappear.