ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

This leaflet has been written by staff working in the Endoscopy Unit at Chelsea and Westminster Hospital. 

We hope you find it useful. If, after you have read it, you have any questions or concerns, please ring us on our direct line 020 3315 3056/5223.

When you come into the Unit (2nd Floor, Lift Bank B), please talk to us about any worries and ask any questions you have.

If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team on 0203 315 4141/5984 or email us Chelwest.cwdiagnosticcentre.admin@nhs.net.

Your appointment time in Endoscopy is approximate because some procedures may take longer than expected and emergency procedures need to take priority. Please expect to be in the department for several hours having pre-procedure checks, the procedure and for recovery after the procedure. 

What is an ERCP?

An ERCP is an examination of the bile ducts and/or pancreas. Under sedation, a long flexible telescope called an endoscope is passed through the mouth into the oesophagus (gullet), stomach and duodenum (small bowel).

After insertion of a catheter and wire into the ducts, dye will be injected into the bile/pancreas ducts (tubes), X-rays are then taken to outline these ducts. Any treatment that the attending doctor considers necessary will be done at this time. This is likely to include a sphincterotomy (cut at the bottom of bile duct to allow drainage of bile and allow treatment.) Other treatment may include removal of stones, stretching opening any narrowings, biopsies, and inserting a stent (plastic or metal tube) to allow bile to flow if there is a blockage.

What should I do before I come in?

As you will be having sedation, you must organize for someone to take you home after the test and be with you for 24 hours. 

If you are diabetic please let us know in advance.

Unless advised otherwise, if you are taking any of the following medicines, please inform the pre-assessment nurse or a member of the Endoscopy team for further instructions:

• Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
• Clopidogrel, prasugrel, ticagrelor, dipyridamole
• Any other medication used to thin the blood 

On the day of the ERCP

You should not eat or drink anything for 6 hours prior to the test, with the exception of clear fluids which can continue until 2 hours prior to the test.

What are the benefits and risks ?

ERCP will allow us to accurately diagnose and treat problems relating the bile ducts or pancreatic duct. There is a 2–5% risk of pancreatitis. Bleeding, infection of the bile ducts and perforation occur about 1 in 500 times but are up to 10 times more common if a sphinctectomy (cut) is performed. The procedure has a 1 in 500 chance of death.

Other complications include chest infection and a slight risk to teeth or dental bridgework. Sedation causes breathing problems in about 1 in 200 cases, usually mild. Laparotomy (surgery) and/or blood transfusion is very rarely required following procedure. 

Sometimes it may not be technically possible to complete the procedure and rarely a procedure to drain bile via placement of a drain through the skin and liver into the bile duct may be required.

Sedation for the procedure

Sedation (given through an intravenous cannula) will be required for you to tolerate the procedure, and enable an adequate quality examination to be completed.

The type of sedation required for your procedure will depend upon exactly what the doctor is looking for, if any treatment or particular biopsies are required, as well as other factors such if a separate procedure is planned on the same day (eg ERCP).

The medical team will determine this prior to your booking.  Sometimes they may determine that a general anaesthetic is necessary, and if that is the case you may need to be assessed by an anesthetic doctor prior to the procedure.

Please note with sedation or General anaesthesia, even if you feel wide awake your reactions may still be affected. You may find it difficult to concentrate and you may forget things that you have been told after the procedure. The nurses will give you written discharge information. This includes the advice that for 24 hours after sedation you should not drive, ride a bicycle, operate machinery, take sedatives or drink alcohol, or sign legal documents. 

After receiving sedation or general anaesthesia your escort must collect you from the unit, take you home and be with you for the next 24 hours. We cannot escort you home.

What will happen when I come in?

On admission to the unit a nurse will ask you several questions about your health, current medication (please bring an up-to-date list with you), and take your blood pressure and pulse, and ask you to get changed into a gown.

Please leave any valuables at home, as we cannot be responsible for any valuables lost whilst you are in the unit.

You do not need to bring anyone with you to your appointment, unless they are acting on your behalf (eg interpreting for you). Your escort/relative will only be needed when you are discharged if you have sedation. Please avoid bringing cash or valuables with you.

Prior to the test, you will be seen by the endoscopist doing the test for you. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.

Please note that you may have to wait for some time on the day of your procedure as occasionally there are emergency inpatient cases which need to be accommodated.  Rarely there may be a need to rearrange your procedure for another date, we will do anything possible to avoid this if at all possible.

What will happen during the procedure?

In the procedure room you will lie on the ERCP bed on your front, but with your head turned to the right side in most cases. Two nurses and the endoscopist will stay with you throughout the test. You will be asked to bite on a small plastic mouthpiece to help keep your mouth open. This will also help to protect your teeth during the test. Dentures have to be removed if they are loose.

During the test you may be given oxygen through little prongs that fit just inside your nostrils. Your blood pressure, pulse and oxygen levels will also be monitored.  The endoscope will not interfere with your breathing. 

During the test air is passed down the endoscope into your stomach to get a clear view. This may make you burp. The air is sucked out at the end of the test. If you get a lot of saliva in your mouth, the nurse will clear it using suction (the sort of tube that is used when you go to the dentist).

FAQs

Will I get the results of my test on the same day?

A: Before you go home you will be given the results of the test. It will also say whether you need an appointment with a consultant or with your GP. Your GP will receive a copy of the report of the examination from the hospital. If biopsies were taken these results take longer and will be sent to your consultant.

What happens to my medication?

We will talk to you before you go home about any changes/additions to your medications.

What can I expect when I go home?

You may feel bloated if some air remains in your stomach. It is advisable to sit upright and if possible walk around to help relieve this. Warm drinks and peppermints will also help you to pass the wind. You may have a sore throat, which can last up to 48 hours. Taking throat lozenges will help. Pain relieving tablets such as paracetamol may be taken according to manufacturer’s instructions.

If you develop any of the following symptoms in the 72h after the procedure you should seek urgent medical attention by attending your nearest emergency department taking with you your ERCP report:

• New and persistent (lasting more than a few hours) abdominal pain or back pain
• Fevers / shivering
• Vomiting blood, or passing altered blood in your bowel motions or jet black coloured bowel motions