ERCP

During the procedure, an endoscope (a flexible instrument) is passed through your mouth, into the oesophagus and stomach and then into the first part of the small intestine.

This is the area of the bowel where the ‘drainage tubes’ (“bile duct” and “pancreatic duct”) connect onto the bowel. Fine instruments can then be placed through the endoscope and passed into the bile duct and/ or the pancreatic duct. X-Ray dye is injected for targeted X-ray to obtain a picture of these ducts. Sometimes a small cut is made into the muscle surrounding the opening to the bile duct (“sphincterotomy”) to allow better drainage of the bile duct or to perform other procedures eg: remove stones, biopsy, place stents (drainage tubes) or stretch narrowing of the bile duct

You should not eat or drink for at least six hours before the procedure to make sure you have an empty stomach, which is necessary for a safe examination. Generally, you should take all your regular medications with a sip of water, even on the morning of the procedure. However, if you are taking blood-thinning medications (such as aspirin, persantin, warfarin or Plavix or Iscover), your doctor will need to discuss whether these should still be taken in the weeks before the procedure. Let your doctor know about any allergies you have to medications (especially antibiotics), iodine or intravenous contrast material.

If you are diabetic your doctor will need to make special arrangements to ensure that your blood sugar is managed well around the time of the procedure. X rays are used as part of the procedure. Therefore, it is essential to tell your doctor if you could be pregnant.

You will receive an intravenous sedative to make you more comfortable. Some patients also receive antibiotics before the procedure. Most people remember little or none of the procedure. The instrument does not interfere with breathing, but you might feel a bloating sensation because of the air introduced through the instrument.

ERCP is a safe and well-tolerated procedure when performed by specialist doctors trained and experienced in the technique. Although complications requiring hospitalisation can occur, they are uncommon. Complications can include:

Pancreatitis (inflammation of the pancreas)

Infections

Bowel Perforation

Bleeding

Risks vary, depending on why the test is performed, what is found during the procedure, what therapeutic intervention is undertaken, and whether a patient has major medical problems. Pancreatitis is the most frequent serious complication and causes pain in the abdomen. It is usually mild and settles within a couple of days in hospital with pain relief, bowel rest and intravenous fluids. However, occasionally pancreatitis can more severe, and very rarely can even result in death. Since the risks vary with each patient you should have a detailed conversation with your doctor about the risks to you.

If you have ERCP as a day only procedure, you will be observed in the recovery unit until most of the effects of the medications have worn off. You might experience bloating or pass gas because of the air introduced during the examination.

Your doctor may recommend dietary restrictions for 1-2 days following the procedure. You will require someone to accompany you home from the procedure because of the sedatives used during the examination. Ideally, a responsible adult should stay with you overnight. Even if you feel alert after the procedure, the sedatives can affect your judgment and reflexes for the rest of the day. You must not drive until the next day