Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

An 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). The plumbing system of the liver. The most common reasons to do ERCP 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.

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.
• ERCP used to diagnose and treat complications from gallbladder and liver surgery or major trauma (usual leakage of bile).

ALTERNATIVES:

• A CT scan can be performed, but the investigation is less sensitive, and small lesion or growths (less than 1cm) missed, and no biopsies obtained and no treatment is 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 are unsure about any aspect of the treatment proposed, please do not hesitate to speak with a senior member of staff again.

DURING THE EXAMINATION:

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 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) passed through the mouth, down the gullet, into the stomach, and then into the top part of the small intestine (duodenum).

Details:

Sedation ERCP performed with intravenous analgesia and sedation. The medicine is 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 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 the hospital afterwards to allow us to observe you for any late-onset complications.

After the procedure:

• You will transfer to the recovery area. Once your general condition is 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 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 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. This will soon disappear.