Endoscopic Retrograde Cholangiopancreatography (ERCP)
Care Before the Procedure
- Pre-Procedure Evaluation:
- Review of medical history, allergies (especially to contrast dye), and medications.
- Blood tests (coagulation profile, liver enzymes) and imaging (ultrasound, CT, or MRI) to confirm the need for ERCP.
- Fasting:
- No food or drink for at least 6–8 hours before the procedure to ensure an empty stomach.
- Medication Adjustments:
- Hold anticoagulants (e.g., warfarin, clopidogrel) 5–7 days prior to reduce bleeding risk.
- Adjust diabetes medications due to fasting.
- Informed Consent:
- Discussion of risks (e.g., pancreatitis, bleeding, infection, perforation) and benefits.
- Arrangements:
- Arrange for transportation home post-procedure due to sedation.
Care During the Procedure
- Setting: Performed in a hospital endoscopy suite or radiology department.
- Anaesthesia: Typically performed under conscious sedation or monitored anaesthesia care (MAC).
- Process:
- The endoscope is passed through the mouth into the duodenum.
The ampulla is identified, and a catheter is used to inject contrast dye into the ducts. - X-ray images are taken to identify abnormalities.
- Therapeutic interventions (e.g., stone extraction, stent placement, sphincterotomy) are performed as needed.
- The endoscope is passed through the mouth into the duodenum.
- Duration: 30–90 minutes, depending on complexity.
- Patient Experience:
- Sedation ensures comfort; patients may feel slight bloating or pressure.
- Vital signs are monitored throughout.
Care After the Procedure
- Immediate Recovery:
- Monitor for 1–2 hours until sedation effects wear off.
- Watch for signs of complications (e.g., abdominal pain, fever, bleeding).
- Post-Procedure Instructions:
- Resume a light diet once swallowing returns to normal.
- Avoid driving, operating machinery, or consuming alcohol for 24 hours.
- Symptoms to Report Immediately:
- Severe abdominal pain, fever, chills, vomiting, or black stools (may indicate pancreatitis, infection, or bleeding).
- Follow-Up:
- Discuss results and further treatment plans (e.g., surgery, additional ERCP) during a follow-up appointment.
- If a stent was placed, schedule a repeat ERCP for removal or replacement as needed.
- Long-Term Management:
- Lifestyle modifications (e.g., low-fat diet) to prevent gallstone recurrence.
- Regular imaging or blood tests to monitor underlying conditions (e.g., tumours, strictures).
- Note: ERCP is a complex procedure with a higher risk of complications compared to standard endoscopy. It should be performed by experienced endoscopists at specialised centres. Patients should strictly follow pre- and post-procedure instructions to minimise risks and ensure optimal outcomes.
Eligibility
- ERCP is typically recommended for patients with:
- Gallstones lodged in the bile duct causing obstruction, jaundice, or pancreatitis.
- Bile duct strictures (narrowing) due to tumors, inflammation, or surgery.
- Pancreatic duct abnormalities (e.g., stones, strictures, leaks).
- Unexplained abdominal pain with evidence of duct dilation on imaging.
- Suspected tumors of the bile duct, pancreas, or ampulla.
- Pre-Procedure Evaluation:
- Review of medical history, allergies (especially to contrast dye), and medications.
- Blood tests (coagulation profile, liver enzymes) and imaging (ultrasound, CT, or MRI) to confirm the need for ERCP.
- Fasting:
- No food or drink for at least 6–8 hours before the procedure to ensure an empty stomach.
- Medication Adjustments:
- Hold anticoagulants (e.g., warfarin, clopidogrel) 5–7 days prior to reduce bleeding risk.
- Adjust diabetes medications due to fasting.
- Informed Consent:
- Discussion of risks (e.g., pancreatitis, bleeding, infection, perforation) and benefits.
- Arrangements:
- Arrange for transportation home post-procedure due to sedation.
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