DIAGNOSTIC FACILITIES
ERCP
ERCP is a procedure which enables the doctor to examine the common bile duct and the pancreatic duct. The doctor passes a tiny camera on the end of a narrow and flexible tube called an endoscope (or "scope") through your mouth, stomach and into your small intestine (bowel). Then diagnostic and therapeutic procedures can be performed and tissue or biliary samples obtained to detect infection, obstruction or any other abnormality.
ERCP allows the doctor to establish reasons for jaundice (yellow skin), abnormal liver function, gallstones, biliary and pancreatic inflammation. This will benefit you by providing a clear diagnosis. Sometimes doctors will first perform an MRI scan of the bile ducts and pancreas called an MRCP. If you prefer not to be investigated, we advise you to discuss the implications with your doctor.
What preparation will I need?
This procedure must be performed on an empty stomach, so you must not eat or drink for six hours before the procedure.
What about my medications?
If you are taking anti-inflammatory tablets (such as neurofen, brufen or voltarol) please stop taking them 5 days before your test.
Do not stop taking aspirin, clopidogrel or warfarin but please make sure that you have discussed this with your referring doctor before the test. There is a significant risk that a coronary stent will block if these medicines are stopped within one month of stent placement; and a slightly increased risk within the first six months. If the referring doctor thinks it is in your best interests to stop taking them, they should be stopped 10 days before the ERCP.
If you are a diabetic, please let the unit know. We will give you more detailed information about your preparation.
What happens on the day of the test?
Please bring your medication, a dressing gown and an overnight bag in case you need stay in hospital after the test. Please book in with the endoscopy reception staff when you arrive. They check your personal details, such as your name and address. We try to ensure that all patients are seen and have their tests within a short period of time of arriving in the unit, but occasionally emergencies take precedence and you may need to wait. The reception staff will keep you informed in the event that this happens.
One of the endoscopy nurses then sees you and asks you some further questions. Before you undergo the test, the doctor (endoscopist) who will be doing the procedure will talk you through the consent form and the potential complications. It is important for you to think about these in advance so when you sign the form agreeing to the test you are comfortable that it is a test you really want. Remember, you can change your mind about having the procedure at any time. Please tell the doctor if you have heart valve disease or if you normally are given antibiotics when you visit the dentist. X-rays are taken during this procedure so please tell the doctor if you could be pregnant.
Before the test starts, the doctor or nurse puts a small needle into the back of your hand. This is to give you some sedation and some painkillers. These drugs are used together to reduce the discomfort you may feel and to make you a little sleepy. This is not a general anaesthetic.
An ERCP usually takes between 30 minutes and 1 hour, depending on what is done. Local anaesthetic is sprayed on to the back of your throat to make it numb. A sedative and analgesia (painkiller) are administered through a drip in your arm to make you drowsy.
A plastic mouthpiece is placed between your teeth to keep your mouth slightly open. When the endoscopist gently passes the endoscope through your mouth you may gag slightly - this is quite normal and will not interfere with your breathing. The endoscope is thinner than an index finger.
During the procedure, some air is put into your stomach so that the endoscopist can have a clear view - this may make you burp a little. Some people find this uncomfortable but it does not hurt or affect your breathing. The air is removed at the end of the test.
The procedure itself requires the doctor to pass the endoscope beyond your stomach into the small intestine (bowel). Water-soluble dye is injected into the bile ducts to allow the doctor to visualize the pancreas and common bile ducts. Photographs or video may be taken, and bile samples, brushings or biopsies (tissue samples) obtained. Often the doctor needs to perform therapeutic interventions like inserting a hollow tube, called a stent, into the bile duct; expanding a narrowed area (called dilating a stricture); removing gallstones or widening the entrance to the biliary system (called a sphincterotomy). Throughout the procedure a nurse cares for you and monitors your pulse and oxygen levels.
What are the complications of ERCP?
About 1 in 20 patients suffer from inflammation of the pancreas (called pancreatitis) after the procedure. This usually requires admission to hospital for several days, but occasionally may require longer stays.
Bleeding, cholangitis (infection of the bile ducts), or a hole (a perforation) occur about 1 in 500 times but are up to 10 times more common if a sphincterotomy is performed. If such a complication occurs, patients usually stay in hospital for a few days.
Using sedation can cause breathing complications in up to 1 in 200 procedures, which usually are not serious, but to reduce this we monitor your pulse and oxygen levels at all times throughout the test.
Other rare complications include aspiration pneumonia, damage to loose teeth or to dental bridgework.
The procedure has a 1 in 500 mortality rate.
If you have severe pain, black tarry stools or persistent bleeding, you should contact your nearest A&E Department for further advice and also inform us.
What happens after the test?
You are either moved back to the recovery area where a nurse monitors you for 1-2 hours whilst you sleep off the sedation, or you are returned to your ward.
You will be given fluids via a drip until you are able to eat and drink. You may experience bloating if there is still some air in your stomach, and a sore throat. Both sensations are normal.
If you are going home the same day you must arrange for someone to escort you home. Be aware that parking at the hospital is very limited. If no escort is available, please bring enough money to pay for a taxi. No escort is required if you are using hospital transport.
We strongly advise that you do not drink alcohol, operate machinery, drive or make important decisions for 24 hours after your procedure as sedatives can impair your judgement.
You can resume normal activities, work etc the following day.
How will I get the results?
The endoscopist will be able to tell you the results after the procedure. If you had sedation, it is a good idea to have someone with you when this occurs because the sedation can make you forget what is discussed. If samples were taken, you will be told the final diagnosis by your doctor within about 1 week. Copies of your ERCP report will be sent to your GP.
If you have any problem understanding or reading any of this information, please contact the Endoscopy Unit staff on 0207 483 5164.