ERCP

This is a procedure usually performed under a general anaesthetic to examine the bile and/or pancreatic duct. You will need to lie on your tummy whilst the procedure is done.

It involves passing an endoscope through to the mouth to the duodenum. You will need to fast at least 4-5 hrs prior to the prcocedure.
Special instruments – cannula/autotome/balloons/wire are used to assess and manage the problem.

Common reasons to perform this procedure are:

1. patient has CBD stone
2. the patient has a bile leak
3. the patient is jaundiced (yellow). this can be related to a stone (most common) but also due to a cancer.
4. Blood tests and scans indicate a problem with the bile duct/pancreas and assessment of these ducts are necessary.
5. removal of stents.

The procedure can take anywhere from 20 minutes to 1 hour to do. After the procedure the patient will be kept fasted for 4hrs. If there is no pain and the patient is well ; the fluids can be commenced. this procedure can be done as a day procedure but may involve an overnight stay.

Risks:

1. pancreatitis : this can occur in 5% of patients. It relates to the pancreas being inflamed and the patient will have pain after the procedure. there can be bloating/vomiting/nausea and feeling generally unwell. It may require staying in hospital for unto 1 week. Pancreatitis can be mild, moderate or severe and very rarely (< 0.1%) patients an die from this complication.
2. bleeding – this can occur from cutting the biliary sphincter. It may require injection of adrenaline/cliiping and possibly a return to the procedure room for a repeat procedure.
3. cholangitis – if the bile duct does not drain well; infection can occur. The patient will receive antibiotics at the time of the procedure.
4. perforation of the bowel /sphincter – a rare complication but can occur from the endoscope bowing out and traumatising the lateral wall of the duodenum. This can also occur from cutting the sphincter which leads to a perforation of the sphincter/bowel. This may require further procedures/operation to deal with this issue. Its a significant complication.
5. need for further procedures. This will occur if a stone can’t be completely removed; if stents are placed; or an inability to access the bile duct.