Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

Benefits of ERCP

• This procedure can help us to identify any abnormalities in the biliary system (liver, gall bladder, and pancreas).
• A biopsy (tissue sample) obtained during the investigation.
• Gallstones in the bile duct 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 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.
• Endoscopic Retrograde Cholangio Pancreatography also used to diagnose and treat complications from gallbladder and liver surgery or major trauma (usually leakage of bile).

ERCP generally safe but complications can sometimes occur.

Minor complications:

• 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 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 very rare, severe pancreatitis fatal (less than one in 500 cases).
• If sphincterotomy is performed, there a risk of bleeding which usually stops quickly by itself. However, in severe cases, blood transfusion or an operation may required to control the bleeding. This rarely 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 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 fatal.
• Infection can occur in the bile ducts but we will usually give you antibiotics to help prevent this. Rarely if there 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 very rare).

• A CT scan can perform, but the investigation less sensitive, and small lesions or growths (less than 1cm) missed, and no biopsies obtained and no treatment undertaken.
• An ultrasound scan can provide ultrasonic images of the biliary system, but no biopsies obtained and no therapeutic intervention (treatment)  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 unsure about any aspect of the treatment proposed, please do not hesitate to speak with a senior member of staff again.

Procedure:

Before the procedure starts, a nurse will attach monitors to one of your fingers to record your pulse and oxygen level. You will need to 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 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 pass through the mouth, down the gullet, into the stomach, and then into the top part of the small intestine (duodenum). Sedation ERCP performed with intravenous analgesia and sedation.

The medicine given via a cannula in your hand or arm. It will relax you and may make you drowsy but not put you to sleep. You will hear what said to you and able to respond to any instructions given to you. If you very ill or the doctor concerns, you may given a general anesthetic for this procedure.

The actual procedure takes about one hour. You may need to stay overnight in the hospital afterward to allow us to observe you for any late-onset complications.

Valuables:

Please do not bring in valuables, jewelry, or large sums of money. If this unavoidable, please ask a relative to take them home for you. If this not possible, hand in any valuables to the nurse in charge of your ward on your arrival. They listed and locked in a safe and you given a receipt. The hospital cannot accept liability for the loss of items that 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 closely monitored – an insulin infusion (sliding scale) set up in the ward before the procedure.

Do not take aspirin on the day of your procedure.

Please tell your doctor if you 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 the 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 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
• Jewelry (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.

what happens after the procedure?

• You will transfer to the recovery area. Once your general condition stable, you 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 afterward.
• 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 the 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 Endoscopic Retrograde Cholangio Pancreatography. This will soon disappear.