Endoscopic Retrograde Cholangio-Pancreatography
What is ERCP?
An ERCP (Endoscopic Retrograde Cholangio-Pancreatography) procedure allows the endoscopist to take detailed X-rays of the bile duct and/or pancreas. You will lie on an X-ray table and the doctor who is to perform the test will explain what will happen. Your throat will be numbed with a special spray and you will be given an injection which will make you very sleepy. Once you are sleepy, an endoscope (a long, thin flexible tube with a bright light and video camera at one end) will be passed through your mouth, down into your stomach and the upper part of the small intestine (the duodenum). X-ray dye will be injected down the endoscope so that the pancreas and bile ducts may be seen on X-ray films. If everything is normal, the endoscope is then removed and the test is complete. The dye is passed out of your body harmlessly. If the X-rays show a gallstone, the doctor will enlarge the opening of the bile duct, this is done with an electrically heated wire (diathermy) which you will not feel. Any stones will be removed and collected into a tiny basket or left to pass into the intestine. If a narrowing or other abnormality is found then the endoscopist may take a sample of cells from the duct (known as ‘brushings’) to send for further analysis. Occasionally, if a blockage is found, a short tube (endoprosthesis) may be placed in the bile or pancreatic duct, to enable drainage. You will not be aware of the presence of the tube, which may remain in place permanently or be removed at a later date.
Before the procedure
To allow a clear view, the stomach and duodenum must be empty. You will therefore be asked not to have anything to eat or drink for at least six hours before the procedure. When you come to the department, the procedure will be explained and a doctor will ask you to sign a consent form to ensure you understand the test and any potential complications. Please tell the nurse or doctor if you have had any previous endoscopic examinations, or reactions to drugs or allergies. In some situations, antibiotics are given by injection before the procedure. If you have any worries or questions at this stage don't be afraid to ask, the staff will want you to be as relaxed as possible for the test and will not mind answering your queries. You may be asked to take off your shirt or jumper and to put on a hospital gown. It will also be necessary for you to remove any false teeth or contact lenses. Jewellery or metal objects should also be removed because they interfere with X-rays and a special instrument called a diathermy. They will be kept safely until after the examination.
After the procedure
When you return to the unit, you will feel sleepy. The nurse will advise you when you can eat and drink. The results of the test and any treatment given will be explained and you should be allowed to leave the same day. You will usually be given an envelope with a copy of the report of the procedure and a copy will also be sent to your GP.
If you are having an ERCP without any additional treatment it is likely that you will be allowed home after the test, but it is essential that someone comes to collect you. Once home, it is important to rest quietly for the remainder of the day. Sedation lasts longer than you think.
You should not:
- drive a car
- operate machinery
- drink alcohol
The effects of the test and sedation should have worn off by the next day when most patients are able to resume normal activities. If you are required to stay in hospital, the average length of stay is between 1-3 days, but it may be much longer if several procedures are necessary or if problems arise.
What are the risks and complications?
Fortunately, these procedures are safe and complications are rare. Potential serious complications include bleeding, perforation (making a hole in the lining of the GI tract), infection and pancreatitis (inflammation of the pancreas). If you have any problems after ERCP which you feel may be related to the test, please inform your doctor or hospital staff at once. An operation may be necessary to treat a complication, but this is very rare. Again, please do not hesitate to discuss possible complications or risks with the endoscopist before ERCP.
What to expect after ERCP
Sedation given during the procedure will make you less alert and sleepy. Do not make any major decisions or sign any legal documents on the day. Do not drive for 24 hours after the procedure or drink alcohol, and avoid any strenuous exercise for 48 hours. You may resume all other activities on the day of the procedure.
Food and drink
It is advisable that you avoid large or rich meals for the day following your procedure and some people prefer to take fluids only for the first 4-6 hours after the test before eating. Alcohol in combination with the sedation you will have received is likely to make you much more sleepy than usual. A mildly sore throat is not unusual and should resolve within 24 hours, taking lozenges will help.
It is not uncommon to experience some discomfort immediately following the procedure due to air in the stomach, this is usually mild and will soon pass. Very rarely more severe abdominal pain, sickness and a temperature may occur due to inflammation of the pancreas, this is called Pancreatitis and it is unlikely that this will happen. If your procedure is being performed as a day case and pain develops later, consult your own doctor, contact the Endoscopy Unit or go to the Accident & Emergency Department of your local hospital (taking a copy of the ERCP report with you).
You may resume normal medications immediately after your ERCP, however we may advise against taking certain blood-thinning or anti-inflammatory drugs for a defined period. Please ask if you are not sure if your medication will be safe to take with the sedation.
Things to report to your doctor
- Severe pain or vomiting
- Passage or vomiting of blood
- Temperature greater than 38 degrees
If you have any worries please do not hesitate to contact either the Endoscopy Department, your own GP or go to the Accident & Emergency Department of your local hospital (taking a copy of the ERCP report with you).