This information is for patients who are having a endoscopic retrograde cholangio-pancreatography (ERCP).  It tells you what is involved and any risks that there may be. The test itself lasts about 30 minutes and normally you will be able to go home 60-90 minutes later.

What is an ERCP?

This procedure is used to treat conditions such as jaundice or abdominal pain caused by diseases affecting the bile duct, pancreas or liver. An endoscope (a thin flexible camera tube) is passed via the mouth into the stomach then duodenum (first part of the small intestine). The bile duct or pancreatic duct can then be treated using minimally invasive surgery under x-ray guidance. This includes removal of gallstones, placement of stents (drainage tubes) or biopsy.

Preparation for the test

• for this examination to be successful and to have a clear view, your stomach must be empty. It is important to have nothing to eat for 6 hours before your test. You may drink small amounts of clear fluids and take tablets up to 2 hours before.

• if you are taking blood thinning medications (e.g. warfarin or other anticoagulants, clopidogrel or other anti-platelet agents) please inform us. You can continue to take most medications and it is important to do so, but please bring a list of them to the unit. It is important to remember to bring any asthma inhalers or angina sprays with you.

On arrival to the Endoscopy Unit

• a nurse will check your details, blood pressure and pulse. If you are allergic to anything (e.g. medicine, latex, Elastoplast), please tell the nurse.

• the procedure will be explained and you will be asked to sign a consent form confirming that you understand and agree to go ahead.

What does the examination involve?

• a local anaesthetic spray to numb the back of your throat; this has a slightly bitter taste.

• an injection of sedative into a vein in your hand, to make you sleepy. An ERCP is always done with sedation and so it is important for somebody to pick you up from the hospital after the procedure.

• you will have a device attached to your finger, which monitors your heart rate and breathing. Then while you are lying on your left side, a small mouthpiece will be placed in your mouth and you will be given oxygen.

• the endoscope will gently be inserted into your stomach and an x-ray is taken to investigate the bile duct and allow specialist procedures to take place. The nurse will care for you during the procedure by suctioning the mouth. The patient is usually very sleepy during this part of the procedure as the sedation is very effective and stronger than that used for other types of endoscopy.

After the examination

• you will rest for about 30-60 minutes. On recovery you can eat and drink when directed by the nurse.

• it is possible to experience abdominal pain after the procedure and if this happens a painkiller may be given by injection. We also sometimes use a rectal suppository painkiller at the end of the procedure.

• rarely, some patients may stay overnight in hospital and it is a good idea to bring a bag of essentials as a precaution.

• the result of the examination will be available before you go home.  Any biopsy results will take longer.

• even though you feel fully awake after having sedation it is important to arrange for somebody to pick you up from the hospital, or if arranging transport home for somebody to be there to look after you. They can then deal with any problems that may arise, despite this being very unlikely.

• it is important that you do not attempt to drive for 24 hours.

Are there any risks?

This examination is safe but there is a small risk of the following:

• pancreatitis (inflammation of the pancreas) may be caused by ERCP and can require a stay in hospital to have painkillers and intravenous fluids. Very rarely this can be serious and need intensive care treatment.

• a reaction to the sedative. The sedative can affect your breathing making it slow and shallow.

• perforation (inadvertent damage creating a hole in the gut), infection or significant bleeding can be serious but are very rare. This may require admission to hospital and sometimes surgical treatment.

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