Your Endoscopic Retrograde Cholangio-Pancreatography (ERCP) – see inside, treat what is wrong

This quick guide lists the key points you need to know before having an endoscopic retrograde cholangio-pancreatography (ERCP). For further information:

visit https://www.bradfordhospitals.nhs.uk/endoscopy

or call us for a more detailed patient information booklet to be sent to you in the post

What is an ERCP?

A long, thin flexible camera tube is passed through your mouth, down your gullet, and into your stomach and small bowel. A dye is injected into the opening of your bile or pancreatic ducts so detailed x-rays can be taken. It helps treat conditions like gallstones or a narrowing of the bile duct. This usually takes between 30 and 40 minutes.

Why have an ERCP?

This procedure helps us diagnose and treat your symptoms directly. Blockages in the bile duct caused by gallstones can cause jaundice, pain, or infection. These stones can often be removed, or small plastic or metal tubes, known as stents, can be placed across narrowings to let bile flow freely and resolve jaundice.

Who performs the procedure?

A doctor, an endoscopist, with special training will carry out the procedure, and a nurse will stay with you throughout. Trainees may watch or perform the procedure, but always under appropriate supervision. We will ask you if you are happy for them to watch or perform.

Is it painful?

Everyone is different but most people tolerate it well. Some discomfort during the procedure is common but is rarely severe. Afterwards, you may feel some soreness at the back of your throat and have a bloated or uncomfortable, we will always stop if you ask us to.

Choosing pain relief

This procedure is performed under conscious sedation to make sure of your comfort. The table below gives you more information about the pain relief you will receive.

Your option for pain relief

Getting ready

It is important to prepare well for your procedure. Having a completely empty stomach allows us to get good views and avoids the risk of vomiting during the test.

1. Pre-assessment clinic – this will happen 1–2 weeks before your procedure. A nurse will explain the test, take a blood sample, and check your medical history and medications.
2. Day of your procedure – do not eat or drink anything from midnight. You can take your normal medication, unless you are told not to, before 7am with a small sip of water. 

Contact numbers

Questions about your procedure?
Tel: 01274 276393
Monday to Friday
8.30am to 5.30pm

Change your appointment
Tel: 01274 273073
Monday to Friday
8.00am to 4.00pm

If you are unwell after the procedure (inside office hours)
Tel: 01274 276393
Monday to Friday
8.30am to 5.30pm

If you are unwell after the procedure (outside office hours)
01274 364413 (Ward 5) or NHS 111 or Emergency Department
24 hours a day
7 days a week

On the day

1. You will be welcomed by our receptionist who will confirm your identity and give you a wristband.
2. We will have a quick chat to see if anything has changed since your pre-assessment appointment.
3. We will answer any questions you may have and ask you to sign a consent form.
4. You will be asked to change into a hospital gown and remove any jewellery.
5. A cannula will be placed in the back of your hand for your medications. You may also get an antibiotic dose through it.
6. At the start, you may be given an anti-inflammatory suppository to drastically reduce the risk of developing pancreatitis.
7. You will lie comfortably on a trolley mainly on your front/side and a mouth guard will protect your teeth. Dentures will be removed.
8. As you take a small swallow the tube will glide down your throat, then you will be turned to lie flat on your stomach.
9. Air is blown to open-up the view, dye is injected, x-rays are taken, and painless tiny lining samples or therapies are completed.
10. Your procedure is complete and you will be taken back to the ward.
11. You will rest in bed until the sedation wears off. You can generally drink 2 hours later and eat 4 hours later.
12. A nurse will discuss your results with you and a family member if you wish.

How long will the procedure take?

Expect to be on the ward most of the day, as you will be monitored after your procedure, for up to 6 hours. You are usually allowed home late afternoon or early evening.

Going home

Sedation – rest, snack, escorted home. You must have a responsible person stay with you overnight. No driving, machinery, alcohol, heights, sports, or signing legal documents for 24 hours.

Results

The results of the procedure and follow-up plans will be discussed with you before you leave, and you will get a written summary to take home. Any biopsy results will be sent to the hospital consultant who referred you for the test, usually within one month, but this can vary.

What are the risks?

An ERCP is generally a safe procedure and there is always a good reason for doing it. While complications from an ERCP can occur, they are uncommon, affecting fewer than 1 in 20 people. The risk is slightly higher if the procedure involves therapy, such as stone removal. However, the risks of untreated conditions are typically much greater than the risks of the procedure itself.

• Pancreatitis: This affects 1 in 20 patients but is usually mild. Occasionally pancreatitis is severe and even life threatening, but for most people who develop pancreatitis it is mild.
• Bile duct infection.
• Bleeding: More common if a small cut is made to enlarge the duct and may require a blood transfusion or repeat procedure, very occasionally an operation if the bleeding cannot be controlled.
• A perforation or tear through the wall of the gut that may require surgery.
• Allergic reactions to the medication or x-ray dye.
• Heart and breathing difficulties such as a chest infection related to sedation.
• Damage to loose or crowned teeth.

In about 1 in 20 cases, the procedure is unsuccessful and the planned therapy cannot be completed, which means it may need repeating or an alternative planned. Very rarely, a complication can be so serious that it is life-threatening, but death occurs in less than 1 in 250 cases.

If you are worried about complications or feel you are not fit enough, please let us know by ringing us or telling us during your pre-assessment.

The decision to have an ERCP is yours. Alternatives include surgery or a radiological procedure through the liver, but these both carry greater risks than an ERCP. Doing nothing may cause your symptoms to get worse.

Frequently asked questions

1. Will it hurt? Some discomfort during the procedure is common but is rarely severe. Soreness in the throat or wind bloating can happen but passes quickly.
2. Why can’t I be put to sleep? To put you to sleep for a procedure involves giving a general anaesthetic. This is not available routinely and it increases the risk associated with the procedure. It is not required for most patients because the procedure is usually well tolerated.
3. How long will it take? The procedure itself lasts approximately 30 to 40 minutes but expect to be at the unit for up to 8 hours to cover your full care.
4. When do I get my results? See results.
5. Do I need somebody with me afterwards? Yes, you must arrange for someone to collect you and stay with you overnight.