ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY/SPHINCTEROTOMY (ERCP)
ERCP lets your doctor examine the small tubes (called ducts) of the liver, pancreas and gall bladder. You will be given sedation by an Anaesthetist to help you relax. Most patients consider the test only slightly uncomfortable and many patients sleep during the procedure. Some patients are also given antibiotics before or during the procedure.
A thin flexible tube called an endoscope will be passed through your mouth and will produce images on a video monitor. The endoscope does not interfere with your breathing. You will be placed onto your tummy on an X-ray table. The endoscope will be passed through the mouth, food pipe, stomach and into the first part of the small intestine. Through this tube a further fine plastic tube is passed into the ducts of the liver and pancreas. Through this tube contrast material (dye) is injected into the ducts and x-rays are taken. During the procedure stones may be removed and thin plastic tubes (stents) may be left within the bile or pancreatic ducts to help it drain.
To allow a clear view you should not eat or drink anything for a minimum of 8 hours prior to the procedure. Do not take any antacids. If you must take prescription medication use only small sips of water.
RISKS OF THE PROCEDURE:
There are some risks/complications, which include:
- Inflammation of the pancreas (pancreatitis). This occurs in approximately 1 in 20 patients. This may need an admission to hospital for pain relief. Most cases will settle over a 24-48 hour period and will not cause long term damage to the pancreas. Very rarely pancreatitis can be severe and will need further treatment which may include admission to an Intensive Care Unit or surgery. Death has been reported from pancreatitis after ERCP. Recent studies suggest that administration of an indomethacine suppository prior to the procedure may reduce the risk of pancreatitis and this may be given. The placement of a small tube (stent) into the pancreatic duct may reduce the risk of pancreatitis and this may be performed during your procedure.
- Bleeding can occur in 1 in 100 people. This can happen if a cut is made in the bottom of the bile duct where it joins the small intestine (sphincterotomy). The bleeding is usually able to be stopped via instruments passed through the endoscope. Rarely surgery or blood transfusion is needed. Bleeding can occur up to 14-21 days after a sphincterotomy and admission to hospital may be required for further treatment.
- Infection due to bacteria from the small intestine can result. These germs can spread into the bloodstream (septicaemia). This is treated with antibiotics which may be given prior to the procedure.
- A tear through the bowel or the duct walls (perforation) is uncommon. It may need to be treated with surgery in some cases. Infection (septicaemia) may also happen due to the tear.
- Lung infection is uncommon and is due to vomit going into the lungs.
- Your procedure may not be able to be finished due to problems in passing the tube into the bile or pancreatic ducts.
- An allergic reaction to the sedation used is a rare event.
- Very rarely reactions to contrast material may occur.
WHAT CAN I EXPECT AFTERWARDS?
You will be monitored until most of the effects of the drugs have worn off. The throat might be a little sore and you might feel bloated because of air put into your stomach during the test. You can drink fluids that do not contain milk for the rest of the day. You can usually eat normally the next day unless you are told otherwise. Your doctor will explain the results of the examination to you, or arrange a follow up appointment to discuss the results.
WHAT MUST I DO TO STAY SAFE?
For your safety you must:
- Be taken home by a responsible person.
- Have a responsible adult to care for you for 12 hours after the procedure.
- Not drive a car or motor cycle, or operate machinery until the day after the procedure because of the drugs used.
- No make any important decisions or sign any contracts within 24 hours of the test.
- Not drink any alcohol for 24 hours post procedure.
Tell your doctor if you:
- Generally feel ill with or without headache, chills or muscle aches.
- Have a high temperature.
- Have black bowel motions.
- Have feelings of dizziness, shortness of breath or feel faint.
- Start to get sharp pains in the stomach or begin vomiting.