What is an ERCP?

ERCP is a procedure performed under x-ray control using an endoscope, which allows the bile, pancreas and liver ducts to be examined. These ducts are outlined with x-ray dye. If gallstones or a narrowing of the bile duct are found, they can sometimes be treated during ERCP.

Alternatives

An ERCP is one way of looking at your biliary tract and pancreas. However there are alternative tests which you may have already had or which have been discussed with you. Most of these are scans. Unfortunately scans cannot treat problems when found. ERCP also allows biopsies of any abnormal areas to be taken for analysis, stones to be removed or a stent placed. For these reasons, ERCP is often thought to be a more appropriate test.

If you wish to discuss this further, please contact you GP or the doctor who referred you for this test.

What are the risks of having an ERCP?

• A sore throat after the examination is common and should resolve after a few hours.
• There is a small risk of damage to crowned teeth or dental bridgework
• A reaction to the drugs used during the test may require you to stay in hospital.
• ERCP can cause acute pancreatitis (inflammation of the pancreas) in 1 in 50 patients. Antibiotics may be given to help prevent this but it may result in a prolonged stay in hospital and occasionally a surgical operation is necessary to treat it.
• ERCP may result in infection within the bile duct. This is usually treatable with antibiotics that may be given prior to the procedure, but occasionally it may be serious.
• ERCP may result in bleeding particularly if the bile duct needs to be cut. The bleeding can usually be stopped by an injection through the endoscope, but if it is serious a surgical operation may become necessary. If required, a blood sample will be taken before your test to check your clotting levels.

ERCP may cause perforation of the intestine. If this occurs a surgical operation may be necessary.

These complications rarely occur but it is important for every patient to understand that ERCP is usually not a simple diagnostic procedure but is performed as an alternative to open surgery.

How do I prepare for the ERCP?

• If you are a Diabetic or taking Warfarin, Aspirin or Clopidogrel tablets, please contact the Endoscopy Unit.
• If you require ambulance transport, please arrange this with your GP at least seven days before your appointment.
•  If you take any prescription medication take them at the normal time.
• To allow a clear view with the endoscope, the stomach must be empty.
• Do not eat anything for six hours before your appointment time.   You may drink water up to two hours before your appointment time.
• Before the procedure you will be seen by a qualified nurse and the Endoscopist and you will have the opportunity to discuss any problems or worries. 
• You will be asked to sign a consent form indicating that you understand the nature and risks of the procedure. The consent form is a legal document, therefore please read it carefully.
• You will be asked to put on a hospital gown. 
• Please bring your dressing gown and slippers with you.
• Jewellery or metal objects should also be removed because they can interfere with the x-rays. They will be kept safely until after the examination. 
• Please leave all valuables at home.
• Antibiotics will be given before the test.

What will happen during the ERCP?

• Your test will be performed by a qualified endoscopist or a trainee endoscopist under direct supervision.
• A qualified nurse will remain with you throughout the procedure. 
• You will be asked to remove any dentures or glasses.
• A plastic guard will be placed in your mouth to protect your teeth and the scope.
• You will be positioned appropriately on an x-ray table and then given an injection to make you relaxed and sleepy. This is not a general anaesthetic and you will not be unconscious, but it is unlikely that you will remember much about the test.
• A clip will be lightly attached to your finger to record your pulse rate and level of oxygen and your blood pressure may also be monitored.
• You will be given oxygen into your nostrils.
• When you are sedated an endoscope (a flexible tube with a small camera at the end) will be passed through your mouth, down into your stomach and duodenum. X-ray dye is then injected to outline the pancreas and bile duct. The dye passes harmlessly out of your body. If the x-rays show a gallstone, the doctor may widen the opening of the bile duct to enable the gallstone to be removed or a stent (small tube) to be inserted.
• A video recording, photographs and x-rays may be taken for your records and will only be seen by those involved in your care.
• The ERCP will take about 30 - 60 minutes.

What will happen after the ERCP?

• You will be allowed to rest quietly in the recovery area where a qualified nurse will observe you until the main effects of the injection have worn off.
• You will not be able to eat or drink for four hours but will be advised when you can.
• Occasionally, patients can be discharged home the same evening the examination is performed.
• If you are not discharged the same day, you will most likely to be able to leave hospital the following day.

Going home

• Please arrange for a relative or friend to collect you directly from the ward to take you home. Please liaise with the ward staff to arrange collection time. 
• You will not be fit to go home by public transport.
• If you are discharged the same day, once home you should rest quietly for the remainder of the day and arrange for someone to stay with you overnight.
• The after effects of the injection make you sleepy or forgetful for 24 hours after the ERCP.

FOR 24 HOURS FOLLOWING THE TEST YOU MUST NOT

• Drive a vehicle
• Operate machinery
• Drink alcohol
• Sign any legal documents
• Be left alone to care for children

When will I know the result of my ERCP?

• Sedation makes you forgetful, but the endoscopist or nurse, in the presence of your accompanying relative or friend, will discuss the results of the test with you, if you wish.
• A full report will be sent to your doctor. 
• Before you are discharged you should be given clear details concerning follow-up arrangements.

If you have any further questions you should contact:

Freeman Hospital:

• Endoscopy Unit (09.00 - 16.30) - 0191 2231208
• Day Treatment Centre (Ward 21) - 0191 2231294

RVI

• Endoscopy Unit between (09.00 - 16.30) - 0191 2825655

If you have any queries or require any further information out of these hours, please contact your GP or NHS Direct (0845 46 47).