About your ERCP examination

ERCP (endoscopic retrograde cholangio-pancreatography) is a procedure which enables the endoscopist to examine the bile duct and / or pancreas. This will involve the use of x-rays. The amount of x-rays you receive will be strictly controlled for your safety. The staff will be wearing x-ray protective aprons because of their repeated exposure to x-rays.

You will be given sedation and painkiller before an endoscope (a flexible camera tube) is carefully passed into your mouth, down your gullet through your stomach and into the beginning of the small intestine (duodenum).

By using the endoscope, the doctor can examine the opening of the bile duct. A small plastic tube can be passed down the endoscope into this opening (called the papilla) and dye injected into the bile ducts, enabling x-ray pictures to be taken.

If a gallstone (or some other blockage) is found, it can be treated first by making a small cut in the papilla and removing the stone, or by placing a stent to relieve the blockage. You will find a more detailed explanation of this a bit further on in this booklet.

• Have NOTHING to eat, and do not drink milk, for 6 hours before your appointment.
• Have NOTHING to drink for 2 hours before your appointment.
• Please contact your GP surgery or nurse specialist if you are diabetic and need advice regarding your medication.
• Please contact the endoscopy unit if you take warfarin or any other anticoagulant or antiplatelet medicine.

• Because you will be having sedation for your procedure, you will need someone to act as an escort and stay with you for the remainder of the day and overnight. Your escort must come up to the unit to collect you. We cannot take you down to meet them.
• A list of ALL your medication.
• Your reading glasses.
• Wear loose and comfortable clothing.
• Do not bring any valuables with you.

Parking space at the Royal Sussex County Hospital is very limited, so please set off in plenty of time for your appointment and be prepared to wait in the car park queue. Alternatively, your escort may drop you off at the Millenium Wing and then return to the unit to collect you later.

It is very important that you follow all the instructions carefully, or your examination may need to be postponed.

Please report to the desk. Our receptionist will check your details and ask you to take a seat in the waiting room. You will then be called through by a nurse or health care assistant, who will explain the examination / procedure to you and ask you some questions about your medical history. If you are having sedation, please ensure that you have your escort’s contact details with you so that we can call them when you are ready to be collected. If you have any questions or if there is anything at all that you don’t understand, please ask. You will be asked to sign a consent form before the examination / procedure. Please see a copy of the form at the back of this booklet.

If the x rays show a gallstone or a blockage, it will be treated immediately using one of the following methods:

1. Endoscopic sphincterotomy This procedure will be carried out if a gallstone is found. The doctor will enlarge the opening of the bile duct (sphincterotomy), using an electrically heated wire (diathermy) which you should not feel. Any stones can then be collected into a tiny basket and left to pass into the intestine.

2. Endoprosthesis If the x rays show a blockage in the bile duct, the doctor may place an endoprosthesis (a tiny plastic tube called a stent) inside the bile duct itself to help the bile to drain away into the intestine in the normal way. This may be removed at a later date.

3. Spyglass This procedure will be performed if a gallstone is too large to remove by other methods, or if there is a narrowing or blockage which requires direct visualisation and a sample of tissue being taken. The spyglass is a small camera which is passed through the endoscope into the bile duct. It allows direct visualisation, lithotripsy (destruction of the stone/s using shockwaves) or biopsy to be performed. The stones/fragments are then removed from the bile duct and pass into the bowel naturally. The biopsy is sent to the laboratory to be analysed in the normal way.

This treatment for bile duct stones and blockages has been developed and is recommended to you because it is simpler and safer than surgery. However, you should be aware that it is not always successful and that occasionally problems can arise. In around 2% of patients who are treated for gallstones by endoscopic sphincterotomy, bleeding occurs from the incision of the bile duct. If bleeding does occur, it will usually stop within 24 hours. On rare occasions however, it may require an operation. Up to 5% of patients may develop pancreatitis – a painful inflammation or irritation of the pancreas. This will usually resolve itself within a few days. Very rarely, it can be life threatening, and may require an operation. Please speak to the doctor or nurse performing your procedure if you have any concerns.

There is a risk of infection following the use of spyglass cholangioscopy due to the instrumentation in the bile ducts. The infection is called cholangitis. To reduce this risk antibiotics will be given during the procedure.