This leaflet has been prepared to enable you to make an informed decision when you are asked to give consent to the procedure. If you find you have any questions or concerns, please contact the Day Surgery Unit on 01935 384339, or you can speak to the nurse or Endoscopist when you arrive.

What is an ERCP?

ERCP stands for Endoscopic Retrograde Cholangio-Pancreatography. It is a combined endoscopy and X-ray procedure used to investigate and treat conditions that affect the bile duct, gall bladder and pancreas. It is a procedure that allows the endoscopist to examine the tubes that drain bile from your liver and gall bladder. Bile is made in the liver and passes in to the duodenum (small bowel) through the bile duct.  Bile helps to digest food, particularly fatty food. The pancreas is a large gland that makes enzymes (chemicals) these flow into the duodenum (small bowel) and digest food. 

Jaundice, which is a yellowing of the skin and urine, occurs when the tubes draining bile become blocked. ERCP procedure is undertaken to relieve this condition.

An ERCP involves passing a flexible tube with a camera (endoscope) over your tongue, down your throat and into your stomach and through to the small bowel. A tube is passed through the endoscope into the bile duct under x-ray guidance and appropriate treatment is performed. This usually includes an enlargement of the opening of the bile duct called a sphincterotomy. In some cases we may need to put a tube called a stent in to an area where the bile duct is blocked to allow bile to drain.

Preparing for your procedure

It is essential that you have nothing to eat from midnight the night before your appointment.  You may drink clear fluids (no milk) up to 6 hours before your appointment time.

For your own safety it is important that your stomach is empty at the time of examination. Any food or drink taken within this time could damage your lungs if inhaled during the examination.

Important information for patients taking anticoagulants

Before your appointment

  • If you take Warfarin you will be advised to stop your Warfarin 5 days before the procedure if clinically safe. You should have an INR test the day before your procedure. If you have a metal mitral valve, previous stroke or thrombosis or valvular disease you may need heparin injections instead of warfarin.
  • If you take Clopidogrel you will be advised to stop your Clopidogrel 7 days before the procedure.
  • If you take other anticoagulant medication (Rivaroxaban, Apixaban). This will need to be stopped as per advice from the Gastroenterologists.

If you have any questions relating to your anticoagulant medication Please contact Dr Khan and Dr Gotto’s secretary as soon as you receive your appointment on 01935 38480

Advice for diabetics

If you are a diabetic on medication, please follow the information.

If you take tablets for your diabetes:

  • On the evening of your procedure, make sure you have an extra snack before going to bed.
  • On the morning of your procedure do not take any food, drink or tablets for diabetes.
  • If you monitor your blood glucose, check it before coming into hospital. If it is below 4mmols/litre follow instructions for hypoglycaemia.
  • Bring all your medication with you
  • The Day Surgery staff will monitor your blood glucose level.

If you take insulin for your diabetes

Please note if you take long acting insulin ie Lantus (insulin Glargine) or Levemir (insulin Detemir) continue to take your normal dose.

  • On the evening before your procedure, make sure you have a snack before you go to bed. After midnight you may have nothing to eat or drink. In the event of hypoglycaemia please follow instructions below.
  • On the morning of your procedure DO NOT take any insulin or diabetes tablets
  • Check your blood glucose, check it before coming into hospital. If it is below 4mmols/litre follow instructions for hypoglycaemia.
  • Bring all your insulin and medication with you.

Treatment for Hypoglycaemia

  • Take four glucose tablets
  • Repeat blood sugar test after 10 minutes
  • If still below 4 mmols/litre repeat the above
  • Check your blood glucose hourly
  • On arrival at the Day Surgery Unit, you must inform the nursing staff of this episode

If you are unsure what to do please contact the Diabetic Sisters on 01935 384517 for advice before your admission.

Medication

All other medication should be taken as prescribed. Small sips of water can be taken with medication only.

What to bring with you

You may want to bring a book or something to read, you should expect to spend the day. It may be necessary for you to stay in hospital overnight after the procedure and it is advisable to bring essentials.  Remember, your appointment time is not the time of your examination. Please leave any valuables at home.

What happens when you arrive

Your details will be taken and checked by our receptionist. You will be shown to our lounge or a cubicle and a nurse will take your blood pressure and ask you some questions about your health.

Consent

A doctor will explain the procedure to you and answer any questions you may have and tell you of the risks involved. If you are happy to go ahead, you will be asked to sign the consent form.

Risks

Complications, although rare, can occur with this procedure. These include

  • Inflammation of the pancreas (pancreatitis) This occurs in about 3-5% of procedures, the risk is increased if you have had pancreatitis previously or if you have had a sphincterotomy. If pancreatitis is confirmed you would have to stay in hospital for a few days to be treated with an intravenous drip and antibiotics. A diclofenac suppository may be necessary before the procedure if you are at increased risk of pancreatitis.
  • Infection of the bile duct (Cholangitis) If you are at risk you will usually be given antibiotics.
  • Perforation (making a hole) of the intestine or the oesophagus. This is rare and if it occurs, you will be required a stay in hospital or possibly have an operation.
  • Bleeding happens in a small number of patients and usually settles without any treatment or operation.
  • Reaction to the medication. The medication used for sedation can have an effect on your breathing and heart rate, so every patient is assessed individually and monitored throughout the procedure. It is important that you tell us if you have any allergies to drugs or any breathing difficulties.

Please note X-rays will be taken during the procedure and you should inform us if you could be pregnant.

The endoscopist will speak to you before the procedure, so please feel free to ask any questions.

The examination

An ERCP is performed with a local anaesthetic throat spray and sedation.

Throat spray – this will numb the back of your throat making it more comfortable to pass the tube. The throat spray will wear off completely within an hour and you will be able to eat and drink with no further effects.

Sedation – this will be given via a needle in your hand or arm. The sedation will relax you and will make you drowsy.
The sedation will affect your judgement, memory and reflexes for up to 24 hours. As with any other medication, there is a small risk of an adverse reaction to the sedation.

You must be accompanied home and have someone stay with you for the first 12 hours. The effects of the sedative can last up to 24 hours so you should not drive, care for children or dependants,  operate machinery or drink alcohol during that time

What does it involve?

You will be taken to the X–ray room where you will be asked to lie on the table (almost on your front). The nurse will attach monitors to record your blood pressure and pulse. You will be given oxygen through a tube in your nose. A small cannula (tube) is placed in your hand, ready for the sedation and analgesia to be given.

A mouth-guard will be placed in your mouth to protect your teeth and after sedating you the Endoscopist will pass a scope (flexible tube) through this down your gullet, into your stomach and on into your duodenum (small bowel) A fine catheter is then passed down the scope and into your bile duct. A dye is injected and X-rays are taken allowing the Doctor to examine the ducts. The dye passes out of your body harmlessly.

After the procedure

We advise patients that they will stay in Day Theatre until early evening when they will be reviewed by a Consultant. Although we try to get everyone to go home, there is always the possibility that you will have to remain in overnight following ERCP.

  • The Consultant will inform you of the test results on the day of your examination and what treatment has been given once you are fully awake.
  • It is important that you recognise the early signs of complications and contact your doctor if you have severe pain, difficulty in swallowing, vomiting, fever, chills or black stools.

If a follow up appointment is necessary, it will be sent to you.

Frequently asked questions:

When can I eat and drink?

We advise patients to drink fluids two hours post procedure but not to eat until the following day.

When can I go back to work?

We advise that you refrain from work for 24 hours if you have had sedation. You must not operate machinery and your car insurance will not cover you to drive during this time.

Will I be told any results after the procedure?

The Consultant will speak to you after the procedure and explain any results to you. We will discuss the follow-up plan of care. We will give you a copy of your endoscopy report and a patient care report to explain any findings and give you advice for the next 24 hours.

Ref: 17-19-111
Review: 06/21