ERCP

E.R.C.P. is a technique to examine the pancreas and biliary system.  E.R.C.P will normally only be advised after other investigations, including ultrasound, have been performed.  The test is usually only undertaken where it is felt that other less invasive procedures have failed to provide a clear diagnosis or where removal of bile duct stones or blockages of the bile duct by a tumour is likely.  Stones in the bile duct or pancreatic duct can result in severe infection of the liver and bile duct or inflammation of the pancreas and therefore require removal.

How are you prepared?

You need to fast for eight hours before the procedure.  At the beginning of the procedure you will be given an injection of a sedative into the vein to make you feel relaxed and sleepy.  Because of the sedative you will be sleepy for some time after the procedure which normally takes between 15 and 45 minutes and is carried out in the Hospital where X-ray facilities are available.  You will be given extra oxygen to breathe during the procedure.

Special Precautions

X-rays are used as part of this procedure.  It is therefore essential for women that there is no possibility of pregnancy.   You should tell the hospital staff before the procedure if you have any doubt about this.

You should also tell the staff if you are sensitive (allergic) to any drug or any other substance, particulary  Iodine.

What do we do?

The endoscope is passed from the mouth through the oesophagus and stomach into the duodenum.  The opening of the bile duct and pancreatic ducts can then be identified.  The aim of the procedure is to pass a small plastic tube into one or both ducts so that a radio-opaque dye can be injected and x-rays taken.  In about ten percent of patients it is not possible for anatomical reasons to pass the plastic tube into the appropriate duct.  If stones are found in the bile duct it is important that they be removed.  This can be done by sphincterotomy at the time of E.R.C.P.  This involves inserting a small knife into the opening of the bile duct and a cut made to enlarge the opening.  The stone can then be removed.  Bile duct stones can also be removed by surgery but sphincterotomy has the advantage that you will usually only need to stay in hospital for one or two days following the procedure and return to your normal activities much more quickly.

Safety and Risks

The main complication of E.R.C.P. is the possibility that injection of the x-ray material may cause inflammation of the pancreas (pancreatitis).  This complication occurs in 5% to 10% of people and can cause abdominal discomfort severe enough to require hospitalisation for several days.  In rare instances the pancreatitis can be even more severe and mean a lengthy hospital stay, surgery, and even death.

When sphincterotomy is done at the time of E.R.C.P. there are 1% to 3% of patients who may develop complications.  The most significant risk is bleeding which in extreme cases can require surgery.  Other complications can include infection of the bile duct and incomplete removal of stones.Other complications of E.R.C.P. include reaction to sedation.  These are uncommon and are usually avoided by administering oxygen during the procedure and monitoring oxygen levels in the blood.  Rarely, however, particularly in patients with severe cardiac or chest disease, sedation reactions can be serious.  A number of rare side effects can occur with any endoscopic procedure.

Death is a remote possibility with any endoscopic or other interventional procedure.  If you wish to have further details of rare complications you should indicate to your doctor before the procedure that you wish for ALL POSSIBLE COMPLICATIONS to be fully discussed.

Afterwards

The sedative and painkiller you will receive at the time of the procedure is very effective in reducing any discomfort.  It may also affect your memory for some time afterwards.  Even when the sedative appears to have worn off, you may find you are unable to recall discussion or detail about the results of your procedure.

For this reason, a relative or friend should come with you if possible.  You should not drive or carry out any tasks which require decision making and clear thinking for the rest of the day.  Complications are less severe if treated early.  Therefore, if you develop a fever, abdominal pain, vomiting, passing black stools or any other concerning symptoms after you leave the hospital, you should contact the hospital or your doctor immediately.

Stenting

The technique of biliary or pancreatic stenting involves passing a flexible guidewire into the biliary or pancreatic ducts and then passing a specially constructed plastic or metal tube over the guidewire so that one end lies in the bile or pancreatic duct and the other in the duodenum.  The usual reason for inserting such a stent is to relieve blockage of the bile duct by bile duct or pancreatic cancer.  Occasionally, such stents are used for strictures (benign narrowings) of the bile or pancreatic duct or where stones in the bile or pancreatic duct cannot be removed.  Such stents will become blocked over a period of time and usually have to be replaced every three to six months.

Complications of stent placement include all of the above.  Very rarely, other complications such as displacement of the stent into the bowel, perforation of the bile duct or ulceration of the bowel from the tip of the stent can occur.

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