ERCP
What is ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
It is an examination of the bile ducts and pancreatic duct using endoscopic technique with the help of X Rays. This is done by a physician or surgeon who is trained in advanced endoscopic techniques and is a proficient endoscopist. Gastroenterologists are trained in endoscopy and some of them opt to do advanced training in this particular technique which has evolved over the last two decades to be a great treatment modality for many hepatobiliary ailments, It is like a small surgery involving cutting an area within the small bowel where the bile duct as well as the pancreatic ducts open. Hence it is a very intricate procedure and does carry some risk of complications just like a surgery as we generally do it under deep sedation in an Operation Theatre or an advanced endoscopic room with special facilities.
Who requires ERCP?
This is required for:
-Treating bile duct stones
-Treating cancers
-Relieving jaundice due to obstruction
-To treat complications post surgery with stenting
-To treat narrowed areas in the bile ducts
Undergoing a ERCP:
The preparation requires:
-Generally overnight or 8 hours fasting.
-Blood test including clotting studies and an Ultrasound to be performed prior to scheduling the procedure. Also additional imaging may be required to clarify further before the procedure.
-Medications may need to be altered or stopped (eg. Blood thinners), hence full medication list has to be discussed with the Physician/Endoscopist/Gastroenterologist.
-Special cases like those patients with diabetes may need alteration of their medication or even admission prior to the procedure.
-There must be an accompanying responsible adult with the patient. Patients referred from another hospital if stable may be allowed back to the parent hospital after 6 hours of procedure but if procedure is done as an outpatient, an overnight admission post procedure is generally advised.
-Many times patients with pregnancy may require this procedure and in such situations it can be done relatively safely after extensive discussions and weighing pros and cons.
The nurse will check for consent form and arrange for the patient to change. The anaesthetist will see the patient if not already seen as outpatient to complete the checklist and discuss sedation. Once in the procedure room, an IV line is inserted and an airway tube may be inserted in the nose. The patient is put in prone position with head to the right side to face the Endoscopist and sedation will be administered. The procedure itself takes between 15 minutes to 45 minutes and rarely longer.
The patient will be nursed in Recovery or ICU and monitored closely for the next few hours. Every patient is different and reacts differently to the medications and their dose given so the care is improvised to individual needs. However. Most patients are able to drink liquids after 2 hours and all being well they can be moved to the referring hospital or the ward of the same facility depending upon the need and situation. Sometimes it is necessary to monitor the patient in ICU overnight and blood tests may need doing.
-Severe tummy pain
-Bloated and firm tummy
-Vomiting
-Black stools or blood vomit
-Fever or chills
-Sore throat or difficulty in swallowing
-A crunchy feeling under the skin (air leak)
The above signify complications that may occur due to the procedure or any therapeutics that were undertaken and the management is discussed and done accordingly.
Available at:
(with prior appointment please)