Advice after your nerve block for surgery
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What is an ERCP?
An ERCP is a procedure that combines x-ray imaging with an endoscope (camera) examination. It allows the doctor to examine and/or treat conditions of the biliary system (liver, gall bladder, pancreas, pancreatic and bile ducts).
Why has an ERCP been recommended?
The main reasons for having an ERCP are due to jaundice (yellowing of the skin or eyes), abnormal liver function tests or a blockage of the bile or pancreatic ducts. Blockages of these ducts can be caused by stones, strictures (narrowing of the ducts), growths or cancers.
How do I prepare for an ERCP?
You will be asked to be nil by mouth (nothing to eat or drink) for 6 hours before the procedure. This is to ensure that your stomach is empty and thorough visualisation can be achieved. It also reduces the risk of vomiting during the procedure.
It is important to advise us before you attend for the procedure if you are taking any blood thinning medication (e.g., warfarin, clopidogrel, aspirin, rivaroxban). You may need to stop taking these prior to the procedure, so please discuss with your hospital doctor or nurse. Please also alert us if you are diabetic.
As this procedure involves x-rays, you should not have this procedure if you are pregnant.
What happens before an ERCP?
You will be asked to put on a hospital gown and remove dentures, glasses and jewellery. The doctor will explain the procedure to you and ask for your permission to proceed by signing a consent form. A small needle (cannula) will be inserted into your arm or hand to allow for administration of the sedation.
Before the procedure, you will be attached to a monitor to record your blood pressure, heart rate and oxygen levels. You will be given the sedation and once you are asleep the procedure will commence.
An ERCP is generally carried out under Propofol/Deep Sedation with the Anaesthetic Team present. This means that you will be asleep and may not remember the examination. It is not a full general anaesthetic. Deep sedation is given through an intravenous cannula, which is a small tube that is put into a vein in the back of your hand.
After having sedation, you must have someone who can take you home and stay with you overnight.
What happens during the ERCP procedure?
An endoscope is passed through your mouth, into the stomach and round into the beginning of the small intestine (duodenum). A fine wire is then inserted via the endoscope, into the bile ducts and dye is injected (this shows up on x-ray). X-rays are then taken of your biliary or pancreatic system.
If stones are to be removed from the ducts, a small cut (sphincterotomy) will be made at the bile duct opening. A basket or balloon can be passed to grasp the stone and future stones will pass more easily into the intestine.
If required, stents can be placed in the bile ducts to relieve obstruction and allow bile to drain into the intestine. Stents can also be placed in the pancreatic duct if it is narrowed or obstructed. Specimens may be taken during the procedure from the bile ducts using a small brush or foreceps.
During the procedure a non-steroidal anti-inflammatory drug will be given in the form of a suppository.
How long does an ERCP take?
The procedure can last between 15 minutes and 90 minutes. The time we ask you to attend is not the time of the procedure.
What happens after an ERCP?
Following the ERCP you will be monitored whilst the sedation wears off. Generally, ERCPs are completed as day case procedures, so once the team are happy for you to be discharged, you can go home. It is not always possible for the doctor to discuss the findings after the procedure but, depending on the findings, further management and follow up will be arranged.
Normal activities can be resumed when you feel well enough. Because of the heavy sedation, you should not drive, operate machinery or make important decisions for the 24 hours following the procedure.
A report outlining the procedure will be sent to your GP. If a specimen has been taken, this will be sent to the laboratory for analysis. The result of the specimen will be given to you by either the professional who requested the procedure at a clinic appointment or by letter.
What are the potential risks?
ERCP is generally a safe procedure but as with any medical procedure can be associated with a number of complications.
ERCP complications include:
Acute pancreatitis: This develops in about 5 in 100 ERCP cases and usually presents within a few hours of the procedure. Pancreatitis presents with pain in the tummy which can travel to the back associated with sickness. It usually needs hospital admission for 3-5 days for pain relief and intravenous fluids. In very rare cases acute pancreatitis can be a very serious life threatening condition needing admission to intensive care, a long hospital stay and rarely death.
Perforation: Perforation of the bowel is a rare complication of ERCP which occurs in around 2% of cases and presents with severe tummy pain and tummy swelling usually within a few hours of the procedure. The condition needs admission to hospital and usually treated with antibiotics and fluids but rarely needs a surgical operation to repair the perforation and a prolonged hospital stay. A perforation in rare cases my be fatal.
Failure of ERCP: A failed ERCP can occur in about 10% of cases which may need a second ERCP procedure few days later or an alternative interventional radiological procedure.
Bleeding which occurs in 1-2% of cases if a sphincterotomy has been performed; this usually stops by itself.
Aspiration (inhalation of food or fluids into the lungs) can lead to pneumonia, but this risk is minimal in those who have appropriately been nil by mouth before the procedure.
What is the alternative to an ERCP?
Percutaneous trans hepatic cholangiogram (PTC) is an alternative intervention but this does not allow the bile ducts to be seen directly and is not without its own risks.
CT, MRI and ultrasounds are diagnostic procedures but they do not allow for actual treatment. An endoscopic ultrasound scan (EUS) does not allow for the surgeon to remove stones, make a sphincterotomy or insert a stent.
Special precautions
- If you are asthmatic, please bring your inhalers with you and let the nurse know.
- If you are taking any regular medication for diabetes, please refer to a separate leaflet available by telephoning 0300 615 4163 at Wexham Park hospital or 0300 613 6045 at Frimley Park hospital.
- It explains how to control your blood sugar around the time of your procedure as it is important to maintain a blood sugar above 5 mmol/l. Check your blood sugar level and if necessary suck some glucose tablets ahead of your procedure to achieve this. Please bring your diabetic pills or insulin with you to your appointment.
- For patients on oral anticoagulants (warfarin, apixaban, dabigatran, rivaroxaban) OR the antiplatelet drugs clopidogrel or tricagralor, we will advise how these medications should be managed around your procedure. Please contact us on 0300 615 4163 at Wexham Park hospital or 0300 613 6045 at Frimley Park hospital if you have not been contacted regarding the above medication.
- For patients on warfarin, please have your INR checked 7 days before your procedure and call us at 0300 615 4163 at Wexham Park hospital or 0300 613 6045 at Frimley Park hospital with the result.
- Please inform us if you have had a pacemaker/implantable cardioverter defibrillator inserted. Please call us at 0300 615 4163 at Wexham Park hospital or 0300 613 6045 at Frimley Park
- If you have a heart murmur, have had a heart valve replacement, suffer from kidney failure, are in poor health or very frail, please contact us for advice by telephoning 0300 615 4163 at Wexham Park hospital or 0300 613 6045 at Frimley Park hospital.
- If you are taking any other regular medications, please continue to take them.
- Do let us know if you are pregnant, breastfeeding or trying to conceive since this examination involves the use of x-rays.
- If you have a cough or a cold, please telephone us on 0300 615 4157 at Wexham Park hospital or 0300 613 6647 at Frimley Park hospital as it may be necessary to postpone your appointment.
If you are an in-patient and you require any further information or have a question, please speak to your nurse.
Contact us
If you have any queries relating to this information, please contact the Endoscopy service.
About this information
Service:
Endoscopy
Reference:
H/055
Approval date:
31 October 2023
Review date:
1 September 2025
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.