Originator: Pat Mcgainharding Date: April 2011

Version: 3Date for Review: April 2014

DGOH Ref No: DGOH/PIL/00339

Endoscopic RetrogradeCholangio Pancreatography(ERCP)GastroenterologyPatient Information Leaflet

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Contact numbers

If you have any questions or are unsure about any of theinformation provided in this booklet, please contact a member ofthe GI team on one of the numbers listed below.

Russells Hall Hospital - GI UnitTel: 01384 244113 or via switchboard: Tel: 01384 456111.

Ask to speak to the nurse in charge. If the nursing staff are unableto address your questions, they will suggest alternative contacts.

If you have any questions or are unsure about any of theinformation provided in this booklet, please contact a member ofthe GI team on one of the numbers listed below.

Russells Hall Hospital - GI UnitTel: 01384 244113 or via switchboard: Tel: 01384 456111.

Ask to speak to the nurse in charge. If the nursing staff are unableto address your questions, they will suggest alternative contacts.

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What is an ERCP?

Endoscopic Retrograde Cholangio Pancreatography or ERCP is avery useful procedure as it can be used both to diagnose and treatvarious conditions.

The procedure is performed using a duodenoscope which is a slimflexible tube with a light at the tip. It is gently passed in through themouth and passed down into the gullet, stomach and duodenum.Cholangiopancreatography means x-ray pictures of the bile andpancreatic ducts.

During ERCP dye is passed down a channel within theduodenoscope and flushed into the ducts. This gives us importantinformation with the use of x-rays.

What do I have to do?

You should attend the x-ray department for your ERCPexamination as directed. If you are female and aged 55 years orunder you will need to inform staff of the date of your last periodduring your admission, providing you have not had a hysterectomyor been sterilised.

You should not have anything to eat or drink for 6 hours priorto your test.A responsible adult should take you home afterwards andstay with you overnight. You will not be allowed home on public transport.

Can I find out more?

The Department of Health has more information about consentavailable on the DOH website www.doh.gov.uk/consent.

If you have any questions regarding this test please contact the GIUnit on 01384 244113

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Following your procedure you will spend time in the recoveryarea. Providing your recovery has been straight forward andyou have gained full awareness, you should expect to beready for discharge after about an hour.You may not by law be in charge of a motor vehicle or movingmachinery for 24 hours afterwards.You should be aware that the effect of the sedation used forERCP may be prolonged by other medication you may betaking.You will need to remove the majority of your own clothes andwear a hospital patient gown. If you have a lightweightdressing gown you are welcome to bring it with you.

What happens during an ERCP?

If you wear glasses or dentures you will need to remove thembefore the procedure starts.

You will need to lie on the x-ray examination table on your left side.A small cannula will be placed in your hand or arm in order to giveyou sedation and analgesia. The sedation makes you feel relaxedand sleepy but does not put you to sleep.

An absorbent cover will be placed around your neck to catch anysecretions and you will be asked to put a plastic guard betweenyour teeth, this guard protects your teeth and also prevents youfrom biting the duodenoscope. Oxygen will be given to you throughout the procedure and

Consent

You will need to give consent before the doctor or healthprofessional examines or treats you.

As part of your treatment some kind of photographic record may bemade - for example; clinical photographs, video recordings or XRay. You will be told if this is likely to happen. The photograph or recordings will be kept with your notes and will be held inconfidence as part of your medical record. This means that it will benormally be seen by only those involved in providing you with careor those who need to check the quality of care you have received.The use of photographs is extremely important for other NHS worksuch as teaching or medical research. However, we will not useyours in a way that allows your identify to be recognised withoutyour express permission.

You will be asked to sign a consent form once the procedure hasbeen discussed with you. Health professionals must ensure thatyou know enough about the procedure beforehand, and that youare fully aware of the benefits and risks of the procedure.

Once the consent form is completed you will be given a copy tokeep.

If you later change your mind, you are entitled to withdraw consentafter signing.

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the nurses looking after you will monitor you throughout. This is allroutine and perfectly normal.

The duodenoscope will be gently passed through your mouth. Youmay be asked to swallow to allow the duodenoscope to pass. It willthen move down into your gullet, stomach and duodenum.

Air is passed down a channel within the duodenoscope, thisenables the operator to view the lining of the gut more closely. Theair may make you feel full and bloated and want to belch. Thisfeeling will settle down quickly.

Once the area for inspection has been visualised, you will need toturn on your front. Dye will then be flushed into the bile andpancreatic ducts using a special catheter. X-rays are takenimmediately and will show any narrowing (strictures), blockages ofthe ducts or gallstones.

It may be necessary to take tissue samples (biopsies) or cytologybrushings in order to give us more information to help withdiagnosis and treatment.

If x-rays do show that there are gallstones in the duct, we canwiden the opening and remove the stones. If x-rays do show thatthere is a narrowing, a stent; which is a drainage tube, can beinserted into the duct. This allows drainage of bile into theduodenum in the normal way.Once the procedure is completed, the duodenoscope will be gently

Who is treating me?

Amongst the health professionals treating you, there may be adoctor in training, medically qualified but now doing more specialisttraining. They range from recently qualified doctors to doctorsalmost ready to be consultants. They will carry out procedures forwhich they have been appropriately trained. Someone senior willsupervise - either in person accompanying a less experienceddoctor in training or available to advise someone less experienced.

Should I ask questions?

Ask anything you want. The person you ask will do his/hers best toanswer your questions. If they do not know they will find someoneelse who is able to discuss your concerns.

Is there anything I should tell people?

If there is any procedure you DO NOT want to happen, you shouldtell the people who are treating you. It is important for them to knowabout any illnesses or allergies which you have suffered from in thepast.

Remember to tell the team about anything that concerns you oranything which might affect your general health.

removed. An ERCP can take anything from 30-60 minutes tocomplete. Afterwards you will be transferred to the recovery area inthe GI unit where you will be monitored until you are ready fordischarge.

Are there any side-effects or complicationsfrom having an ERCP?

Most ERCPS are done without any problems. Some people have amild sore throat for a day or so afterwards. You may feel tired orsleepy for several hours, caused by the sedative.Uncommon complications can include the following:

There is a slightly increased risk of developing a chestinfection following an ERCP.Occasionally the duodenoscope causes damage to the gut,bile duct or pancreatic duct. This may cause bleeding,infection and, rarely, perforation. If any of the following occurwithin 48 hours after an ERCP, consult a doctor immediately: - Abdominal pain. In particular if it becomes gradually worse and is different or more intense to any 'usual' indigestion pains or heartburn that you may have. - Fever (raised temperature) and shivering. - Difficulty breathing. - Vomiting blood. - Pancreatitis (inflammation of the pancreas) sometimes occurs after an ERCP. This can be serious in some cases.

The risk of complications is higher if you are already in poorgeneral health. The benefits of this procedure need to be carefullyweighed up against the small risk of complications.If you would like more information regarding this procedure pleasecontact the GI unit on 01384 456111 extension 2731.

Alternatives

Although your consultant feels that this is the best way to proceedat present, there may be alternatives dependant on your conditionor treatment. If you wish to discuss this then please speak to eitheryour requesting consultant or GP.

When will I hear my results?

You will be told the results of your test before you ho home. Ifsamples, either biopsies or cytology brushings have been taken,they will be sent to the laboratory for analysis. These will takeseveral days to process. You will usually be informed of the resultsat your next hospital clinic appointment or by appointment with yourGeneral Practitioner.

Aftercare

When your procedure has been completed you will be given anaftercare information leaflet before you leave the department.

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