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Procedure Information ERCP

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Here are answers to some of the commonly asked questions about ERCP. Ask your
doctor if you have additional questions or concerns.

The term "ERCP” stands for endoscopic retrograde cholangio-pancreatography. This means
looking inside the ducts or “drainage tubes” of the liver, gallbladder and pancreas. It is a procedure
performed by a gastroenterologist or a surgeon.
These ducts all drain the secretions from the liver (bile) and pancreas, through a small hole just
beyond the stomach. This drainage hole is called the papilla, and the name of the intestine just
beyond the stomach is the duodenum.
The main instrument that is used to look inside these ducts is the duodenoscope, which is a long,
thin, flexible tube with a tiny video camera and a light on the end. It is a highly specialized
endoscope, designed specifically for examining the ducts. When the duodenoscope is close to the
papilla, a narrow tube (cannula) is passed through the scope and then through the papilla into the
bile/pancreatic duct. Once inside these ducts x-ray dyes can be squirted into the ducts and
x-rays taken.
ERCP can be useful in the diagnosis and treatment of a wide range of diseases of the bile ducts
and pancreas. The x-rays taken during ERCP or biopsies of abnormalities can help to diagnose
the problem. A common treatments performed during ERCP is removal of stones in the bile duct,
which stops them causing pain, infection or blockage of the bile duct. Placement of drainage
tubes (stents) to relieve blockages is another common reason for ERCP. Usually when such
treatments are needed the papilla is widened a little by making a small internal cut

There are important steps that you must take to prepare for the procedure. First, be prepared to
give a complete list of all the medicines you are taking, as well as any allergies you have to drugs,
iodine or intravenous contrast fluid used in many x-rays. It is particularly important to tell you
doctor about any blood thinners you are taking (such as aspirin, warfarin, persantin, Plavix or
Iscover). Your medical team will also want to know if you have any other medical conditions that
may need special attention before, during, or after the colonoscopy. Very important conditions to
mention to your doctor include diabetes, sleep apnoea and past insertions of pacemakers or
internal defibrillators. It essential to tell your doctor if you are pregnant, as x-rays are used during
One very critical step is to fast from solids and milky fluids for 6 hours before the test. This will
make sure there nothing in
your stomach at the time of the test, so you can’t swallow food into your lungs while your sleeping
for the test.
You’ll be asked to sign a form that gives your consent to the procedure and states that you
understand what is involved. If there is anything you don’t understand, ask for more information.
During the procedure, everything will be done to ensure your comfort. An intravenous, or IV, line
will be inserted to give you medication to make you relaxed and drowsy. For all ERCP’s the
standard medication involves propofol, given by an anaesthetist. With this medication, it is very
unlikely you will be conscious or recall anything from the procedure. Sometimes it will be
necessary for the anaesthetist to pass a tube into your airway (intubation) to ensure your safety
during the ERCP.
The time needed for ERCP varies greatly. An average procedure takes about 30 to 45 minutes.
ERCP is a safe and well tolerated procedure when performed by doctors who are properly trained.
Although complications can occur, they are uncommon. Because of the technical difficulty of this
test the most common complication is failure to enter the ducts and this can occur between 5 and
10 % of procedures. .
Pancreatitis (inflammation of the pancreas) is the most frequent, serious complication and occurs
in 1 to 5 % of cases. It is usually mild and settles in a couple of days with pain relief, fasting and
intravenous fluids. Occasionally it can be more severe.
Other rarer complications include bleeding (when sphincterotomy is performed), infection of the
bile ducts, and perforation (putting a hole in the bowel). All these complications can be treated
and death occurs in less than 5 cases per 1000 ERCP’s.
The risks of ERCP vary for each patient, so it’s important that you have a detailed discussion with
your doctor about these risks and alternative tests, before you sign a consent form.
Magnetic resonance imaging (MRI) is the best X-rays non-invasive alternative to ERCP and is
safer. Wherever possible these x-rays will be done. However, it is not possible to take samples
of tissue (biopsies) or perform treatments with MRI.
You will be given a copy of the ERCP report and your specialist will also speak to you after the
procedure. You will also be given instructions about how soon you can eat and drink, plus other
guidelines for resuming your normal routine. Most patients will need to stay overnight in hospital
for observation and will usually be able to leave the following morning.
Minor discomforts may persist, such as bloating, gas, or mild cramping and sore throat. These
symptoms should disappear in 24 hours or less. By the time you’re ready to go home, you’ll feel
stronger and more alert. You must not drive until the day after your ERCP.
Sometimes problems can occur following your discharge home. If you have any significant
pain, chills or fevers or signs of bleeding (dizziness, fainting, passing blood or black
motions) please contact your specialist immediately.
Bleeding following a sphincterotomy can
occur up to 3 weeks following the procedure. If you have difficulty contacting him or her, contact
the hospital where you had the procedure or ring the main SGIS number (08 82769888), or attend
your local emergency department.
Warfarin/coumadin should be stopped 5 days prior to the procedure, UNLESS you have an artificial
heart valve, in which case you should discuss this with your specialist
Clopidogrel (iscover/plavix) should be stopped 7 days prior to the procedure UNLESS you have
a cardiac stent, in which case you should discuss this with your specialist.
Diabetics – please discuss with your specialist, but basic rules are:
Insulin – have half your normal evening dose (if you have an evening dose) the evening prior to the
procedure and bring your morning dose with you so that you can have this after your procedure.
Oral medications – should be stopped 1 to 2 days prior to the procedure depending upon the

Source: http://design.commuserv.com.au/AdelaideGastro/wp-content/uploads/2013/09/ATT-7-ERCP.pdf

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