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What is an ERCP?

ERCP is a test which helps to determine whether there is a problem with your bile duct system or pancreas.

A slim flexible tube with a light on the end (duodenoscope) is gently passed from your mouth into your stomach. The view can be watched on a TV monitor. The opening to the bile and pancreatic duct (papilla) can be seen. A small plastic tube is passed down the duodenoscope into this opening. Dye is then injected which shows up on the x-ray.

ERCP and sphincterotomy

If the x-rays show a gallstone blocking the bile duct, the doctor will enlarge the opening of the bile duct by making a small cut. You will not feel this. Any stones can be collected from the duct with a tiny basket or balloon, or left to pass out into the intestine, where they are passed out later in your stools.

If the doctor cannot get into your bile duct through the opening, a small cut may be made to the side to allow access.

ERCP and stent placement

If the x-rays show a blockage in the bile or pancreatic duct, the doctor may place a small plastic or metal tube (stent) into the duct. This allows bile to drain into the intestine again. If you have been jaundiced, this will relieve the jaundice and you’re itching. Plastic tubes can be removed or replaced at a later date if necessary.

ERCP complications/risks?

How to I prepare for the ERCP?

To allow for a clear view your stomach and first part of your intestine needs to be empty.

You should not have any thing to eat and drink for 4 hours before your test.

If you are a diabetic (especially taking insulin) or you have serious heart, lung or kidney problems, or concerned that a health problem you have may be affected then contact the doctor at the hospital you are having your examination.

Warfarin : These are blood thinning tablets and usually have to be stopped for a period of time before your ERCP, please contact your endoscopy department for advice.

If you have had an operation on your heart or arteries which involves the use of an artificial part such as a heart valve or graft, please contact your doctor as antibiotics may need to be given.

Some patients also have antibiotics given before the procedure, especially if they are jaundiced.

It is important that you inform your doctor if there is a chance that you may be pregnant.

Due to some of the above or other individual reasons, some people get admitted to the hospital prior to their test.

What happens to me during ERCP?

You will require a blood test before ERCP. This will be done usually on the day before or just before, the procedure.

You are taken into the x-ray examination room and asked to lie on your left-hand side. You will see the x-ray and endoscopy equipment around you and the staff wearing x-ray aprons. The amount of x-rays you receive are strictly controlled.

Once in position, your nurse will attach a finger probe, which monitors the oxygen levels in your blood and pulse rate throughout and after the examination.

Sedative drugs make your breathing slow and shallow; therefore we give you a little oxygen via tubes placed in the nostrils.

Sometimes diathermy (gentle cutting with an electrically heated wire) will be used. A special pad will be placed on your leg for safety.

The test usually takes 30 minutes.

How long will I be in hospital?

Generally you can expect to be in hospital for at least 3 hours. Some patients may need to stay overnight. You will usually be notified of this in advance; however it is best to bring a small overnight bag with you.

What happens when the ERCP is finished?

When the ERCP is finished, you will be transferred to the recovery room on a trolley to rest for about an hour. When you have recovered, you will be helped to a chair and given a drink. Please take care because the sedative may make you feel dizzy and a little confused when you get off the examination trolley.

It is for these reasons that, when having sedation, someone must bring you and take you home. If you live alone or do not have anyone who can be with you, please contact your doctor so that other arrangements can be made.

It is quite likely that back of your throat will feel sore for the rest of the day. You may feel bloated if some air remains in your stomach. Both discomforts usually pass without any medication; you may find it helpful to eat light meals for the next 24 hours.

Do I really need someone with me after sedation?

Yes, this is very important. The sedation you will be given can have affects which can last some 24 hours after the ERCP. You can be forgetful and can become sleepy again.

We strongly recommend that for the 24 hours you:

Do not driveDo not return to work or operate machineryDo not sign any important legal documentsAre not left alone, you maybe at risk of injuring yourselfAre not left alone to care for children

If you are an outpatient, the person accompanying you will be contacted to collect you. If you are an inpatient you will be transferred back to your ward.

When do I get the results?

The doctor will explain the test results to you and (if you wish) the results will be told to your carer. They will be written on your discharge form with any instructions that you need to follow.

Will I ever need an ERCP again?

This will depend on the reason for the ERCP, what is found and whether it was possible to complete to test.

It may be necessary to repeat the test after a few weeks if stones have been removed, to check the ducts are clear.

If it was necessary to insert a stent (tube) into the duct during the test, it may need to be changed or removed at some time.

Bile-a fluid produced in the liver and passed into the gut via the bile ducts.

Diagnostic- carried out to find out what is wrong.

Endoscope-a tube for looking inside the body