Endoscopic Retrograde Cholangio - Pancreatography (ERCP)

This guidance is provided to assist with your preparation for your endoscopic procedure. If you feel unclear about how to proceed
after reading this information, please contact the Endoscopy Booking Assessment Nurse, please see contact phone number on the back
of this leaflet.
Please be aware that we are a Teaching Hospital and may have trainees in any areas of your pathway. They will always be
supervised and will always be working at the level of training. If you would rather not have a trainee involved in your care, please inform
the admission nurse. Please be reassured that this will not affect your care.
An ERCP has been recommended for you to examine the bile ducts and occasionally the pancreatic ducts with a view to providing treatment.

An ERCP is usually recommended for the following conditions:
• stones in bile duct
• inflammation of pancreas (pancreatitis) due to bile duct stones/ gallstones
• blockage of the bile duct identified on scans
• strictures (narrowing), tumours or other abnormalities of the bile ducts, gall bladder or pancreas

An ERCP is an endoscopic procedure to diagnose and treat problems in the bile ducts and occasionally the pancreatic ducts.
The endoscopist can take detailed x-rays of the biliary and/or pancreatic ducts.
The procedure is generally done under conscious sedation using a combination of intravenously administered sedative and analgesic
(pain killer) as well as a local anaesthetic spray (throat spray).
In addition, to reduce the risk of post ERCP related pancreatitis we will administer diclofenac (anti-inflammatory) in the form of a rectal
suppository if there are no contra-indications.
An endoscope (a long flexible tube with a light at the end) is passed through your mouth, down into your stomach and into the
upper part of your small intestine (duodenum). The duodenum is where the endoscopist can look at the opening of the bile duct
called the papilla. A fine plastic tube is passed down a channel in the endoscope and x-ray dye is flushed into the bile ducts and/or
pancreatic ducts and this shows up on the x-ray screen. The x-ray dye is harmless and is passed out of the bile duct.
If there is a gallstone in the duct the endoscopist will enlarge the opening of the duct by making a small cut (sphincterotomy) with an
electrically heated wire (diathermy) and/or use a balloon to enlarge the opening (sphincteroplasty). It is painless and enables the
removal of stones from the duct. These stones then pass into your intestine and in your faeces.
If there is a narrowing in the ducts, a plastic or metal stent may be inserted to allow bile to drain providing relief from jaundice.
 

An ERCP is performed to help treat and occasionally diagnose symptoms.

Bleeding: If a cut has been made into the lower end of the bile duct
as part of the procedure then there remains the risk of bleeding.
If there is significant bleeding at the time of the procedure, then it
is often treated through the endoscope. If severe, however, it can
sometimes require blood transfusion and or surgery/operation.
Sometimes bleeding can be a delayed complication occurring
several hours to occasionally few days after the procedure. Hence
the requirement to withhold some blood thinning tablets/medications
before and following an ERCP.

Infection: There is a small risk of introducing infection in the bile
ducts. Antibiotics are given where appropriate to try and prevent this.

Pancreatitis: This is inflammation of the pancreas occurring in
approximately 4% of cases. Often this inflammation is mild and
settles in a day or two, but very occasionally it can be severe,
resulting in a prolonged stay in hospital and even surgery.

Perforation: During the procedure there is a small risk of a tear in
the wall of the oesophagus, stomach of duodenum or bile duct. This
is a serious complication and will result in hospital admission and
further treatment including possibly an operation

Loss of life: If significant complications were to happen then there
remains a risk of loss of life (<1%). However, this does remain a very
rare risk.

Other Risks:
Rarer risks include chest infection and dental damage (we use a bite guard to protect teeth during the procedure).
A small dose of radiation no greater than other standard x-ray tests.
The sedation administered may cause nausea and vomiting, you may become over sedated which could reduce your breathing effort and you may experience a prolonged sedative effect.

An ERCP is usually performed after other tests have demonstrated an abnormality in the pancreatico-biliary system. Other tests e.g.
Ultrasound, MRI or CT may show what the problem is, but only an ERCP will allow us to treat the problem.
Alternatives to ERCP should have been discussed with the referring consultant team and this includes not doing the procedure and/
or opting for alternatives depending on the indication for the ERCP (including operation, stent placement via alternate modalities etc).

You must have nothing to eat for at least 6 hours before your ERCP.
This is to allow clear views of your upper gastrointestinal tract and to reduce the risk of aspiration during your ERCP.
NB: It is important to keep hydrated, please continue to drink
water until 2 hours before your appointment time.
Please bring a list of medication with you to your preassessment
appointment. If you are an inpatient the ward staff will complete these.
All medications should be continued unless advised otherwise by the Endoscopy Booking Assessment Nurse at the time of booking your
appointment. If you have any concerns or are unsure, please contact the Endoscopy Nurse Booking Team, (phone number on the back of
this leaflet).
 

If you have diabetes, please read the ‘extra’ leaflet sent alongside
this leaflet.
This leaflet is specific to controlling your diabetes through the various procedures available within our unit and you will have been sent the
one that corresponds with your specific procedure:
• Guidance for Managing Diabetes for Gastroscopy / EUS /ERCP (PL1249)
This will give you clear instructions on what to do with your medication (including insulin) during the preparation for your test. If
you have not received a copy of this leaflet, please contact us and request a copy (see phone numbers on the back of this leaflet).

Please attend the Gastroenterology & Endoscopy Unit at the time indicated on your appointment letter and book in at reception.
Please leave valuables and jewellery at home where possible as we unfortunately are unable to look after these.
Your details will be confirmed and you will then be asked to take a seat in the waiting area. In readiness for your procedure a nurse
will invite you into a separate room to ask you questions about your health, explain about the procedure and confirm your arrangements
for going home. You will then have the chance to ask any questions that you may have. You will be asked to change into a hospital gown
ready for the procedure.
Your appointment time takes into account the time required to admit you onto the unit. You should therefore not expect to immediately go
through for the test when called. You will be in the department for up to 8 hours due to monitoring after the procedure.
 

A nurse will be with you all the time during your ERCP. You will be lying on an x-ray table on your stomach for the ERCP. Your pulse
rate, oxygen levels, blood pressure and ECG will be monitored and you will be given a little oxygen throughout the procedure. A small
plastic mouth guard will be placed between your teeth or gums to keep your mouth open.
To make the ERCP more comfortable analgesia (pain relief) and sedation is given through the cannula in your hand or arm. Sedation
is not a general anaesthetic and you are likely to be aware of the procedure. Sedation should relax you and you may or may not
remember the procedure afterwards.
The endoscopist will pass the endoscope through your mouth and down to your duodenum (first part of the small intestine after your
stomach). Retching is commonly encountered and usually stops once the endoscope is in position in the duodenum. You will be able
to breathe and swallow normally.
A small suction tube will be used to clear secretions from your mouth if necessary. Gas will be used to inflate your duodenum to allow a
clear view for the endoscopist and wind type discomfort is therefore common and often relieved by passing wind. Some of the gas will be
sucked out through the endoscope when it is being removed at the end of procedure to make you more comfortable.
A fine plastic tube is passed down a channel in the endoscope and x-ray dye is flushed into the bile ducts and/or pancreatic ducts and
this shows up on the x-ray screen.
If there is a gallstone in the duct the Endoscopist will enlarge the opening of the duct by making a small cut (sphincterotomy) with an
electrically heated wire (diathermy). It is painless and enables the endoscopist to remove the stones from your duct.
If there is a narrowing in the ducts, samples may be taken and sent away for further testing. A small plastic or metal tube (stent) may be
placed inside the narrowing to allow the bile to drain.
The ERCP can take between 20 - 60 minutes or more depending on what interventions need to be performed.

You will be taken from the procedure room (Farage unit) to the recovery area in the Farage unit on a trolley and subsequently
transferred to the endoscopy unit. You will continue to have oxygen via nasal cannula and your blood pressure, pulse rate, temperature
and oxygen levels will be monitored regularly. You will be left to rest as much as possible. Your throat may be sore, and you may
feel sickly because of the sedation and the gas used during the procedure but this will pass.
Following your ERCP you will be advised not to eat or drink for 4 hours. This is the time duration during which any complications will manifest.
Providing there are no complications, you will be allowed to go home. This is providing you have had a satisfactory recovery and
you have a responsible adult to take you home and stay with you overnight.
Please bring contact details with you so we know who is picking you up and staying with you overnight.
For 24 hours following sedation you should not:
• Drive/ride a bike
• Drink alcohol
• Operate machinery
• Sign any legal documents
A post procedure leaflet and contact details will be given to you on your discharge from the Unit. If you have any issues or need advice
please contact the Gastroenterology & Endoscopy Unit within working hours (7:45am to 6pm) on 01253 953043 and ask to speak
to the nurse in charge. Out of hours/during weekends and bank holidays please contact Ward 2 on 01253 953402.

Access from the main hospital multistorey car park
We are located in Area 6 - Gastroenterology & Endoscopy Unit, highlighted in orange on the main hospital map. Follow the signs for the
Main Hospital up the escalator/lift towards Area 6, second corridor on the left. Follow the signs down the link corridor, exit to the right via the side
door (external) which is signposted for Patient Entrance to Reception.
Access for drop off/collection only & disability parking
Enter via East Park Drive and follow the road up the hill, take the second left signposted for Gastroenterology & Endoscopy Unit Drop
Off Only, follow the road round to the right.