Ministry of Health
NZ Government
©Copyright
Published:
24/11/2011
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| What is an
E.R.C.P.? |
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| E.R.C.P. is a technique used to study the ducts
(drainage routes) of the gallbladder, pancreas, and liver (the
drainage channels from the liver are called bile ducts). A
specialist doctor performs E.R.C.P. with a duodenoscope; a long,
thin, flexible tube-like instrument.
The duodenoscope is passed through the mouth, oesophagus, and
stomach into the duodenum (first part of the small intestine). The
duodenoscope enables the common opening to the bile and pancreas
ducts to be visually identified. A catheter (narrow plastic tube) is
passed through the internal channel of the duodenoscope to inject
x-ray contrast into the bile and pancreatic ducts. X-rays enable the
doctor to see the images of the ducts, and to photograph them. |
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What should I expect to
happen?
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Before the examination a nurse will ask you some questions about your
health, and inquire about the medications you take. If you take
several, it is useful to bring a list of these with you, to give to
the nurse. The nurse or doctor will answer any questions you have.
E.R.C.P. is performed in a private examination room in the x-ray
department. Nurses will be present to support and monitor you. You
will be required to lie on your stomach throughout. A small
mouthpiece will be placed between your teeth before the doctor
gently places the duodenoscope into your mouth. While carefully
advancing it towards the duodenum, your stomach is filled with air
to identify the way forward. This may cause the sensation of
fullness in the abdomen. Once the duodenoscope is correctly
situated, it remains stationary while the doctor performs E.R.C.P.
using tiny instruments that go through the internal channel. X-ray
contrast will be injected into the bile and pancreatic ducts and
x-ray pictures will be taken.
If a blockage of the bile duct is seen a small cut (sphincterotomy)
at the lower end of it may be made to aid the flow of bile, or the
removal of stones. Occasionally blocked ducts require the placement
of a small hollow plastic tube (stent) inside, to encourage internal
drainage. In some instances it is preferable to allow external
drainage of bile through a fine tube which will come out of the nose
into a bag (termed naso-biliary drainage). On rare occasions the
instruments will be unable to enter the bile or pancreatic ducts,
and in this case E.R.C.P will not be possible.
After your E.R.C.P. you will return to the Gastroenterology
Department where a nurse will monitor your recovery. If your
observations are satisfactory and you are comfortable, you will be
able to drink water after two hours and eat food after four hours.
You can return to your normal diet at home.
A written report of your results will be given to you before you
leave and a copy will be sent to your Hospital Specialist and GP.
The doctor will discuss any serious findings with you before you
leave the department.
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How should I prepare?
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Your stomach and duodenum must be empty for a thorough and safe
E.R.C.P. so you will not be able to eat or drink for at least 8
hours before your appointment. Important medications may be taken up
to 2 hours before your appointment time, with a mouthful of water.
Do not take antacids. You may eat and drink 4-6 hours after the
procedure, depending on your recovery time.
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Have
nothing to eat or drink after 10 pm the night before the
E.R.C.P |
If you suffer from angina or asthma please bring your GTN spray or
inhalers with you. If you are an insulin dependant diabetic, please
bring your insulin with you.
A blood specimen form has been sent to you. Please have blood
samples taken during the 7 days before your appointment.
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Will I be asleep?
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The E.R.C.P. will be performed with sedation and pain relief to keep
you comfortable throughout. A small needle will be placed, usually
into the back of your hand, through which the sedative injection is
given.
This is not a general anaesthetic and you will not be completely
asleep during the procedure, but you will be relaxed and the
medication may make you forget what has happened.
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Going home after sedation
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After you have received sedation you must not drive, operate
machinery, take public transport unaccompanied, drink alcohol or
return to work until the following day. If your transport
arrangements are not as expected after you have received sedation,
you will be sent home through a "Dial a Driver" service at your own
cost. Dial a Driver may suit those who wish to drive their car to
the appointment, and be driven home in it. A Dial a Driver service
familiar with this department's processes can be booked on 0800 422
234. Booking at least one-day ahead is advantageous.
Please arrange to be collected at approximately 4 p.m. on the day
of your appointment. It may be wise to ask your driver to phone the
nurse to check if you are ready, before leaving to collect you. The
contact phone number is (09) 307 4949 x 7357.
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Is E.R.C.P. safe?
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The main complication of E.R.C.P. is inflammation of the pancreas
(pancreatitis) caused by the injection of x-ray contrast. This
occurs in approximately 5% of people and can cause abdominal
discomfort requiring hospitalization. In rare instances pancreatitis
can become severe and mean a lengthy stay in hospital, surgery and
even death. When a sphincterotomy is performed at the time of
E.R.C.P. there are 1-3% of patients who may develop significant
bleeding and /or bowel perforation. On rare occasions these can
require surgery. Other complications can include infection of the
bile duct and incomplete removal of stones.
A sore throat may be experienced for a day or two. Crown or
bridging work on teeth may be at risk during the procedure.
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E.R.C.P.
Endoscopic Retrograde Cholangiopancreatography
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Prior to your procedure a nurse would like to have a 10 minute
conversation with you to assess your health/special needs. This is a
good opportunity to discuss any concerns.
Please phone the gastroenterology nurse for instructions about
taking your medication if you are a diabetic, or if you are using
blood-thinning medication (warfarin, asprin). Telephone (09) 307
4949 and enter 7357.
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