Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is an advanced endoscopic procedure to examine and treat problems related to the bile ducts, pancreas and gallbladder. A special endoscope is passed through the mouth, oesophagus (gullet), stomach and upper small bowel (duodenum) to perform the procedure.

Diagnosis and treatment of problems such as:

• Jaundice (yellowing of the skin or eyes)

• Blockage of bile ducts (due to gallstones or cancer)

• Cholangitis (infection or inflammation of the bile ducts)

• Pancreatitis

• Strictures (narrowing) of the bile ducts or pancreatic ducts

An empty stomach is essential

• You should have nothing solid to eat in the 6 hours leading up to your arrival time. You may drink ‘clear fluids’ only (e.g. water, cordial, clear fruit juice, black tea or coffee WITHOUT milk, soft drinks) until 2 hours prior to your arrival.

• After that you must remain strictly nil by mouth, apart from a sip of water to take important regular medications, but NOT diabetic or blood thinning medications.

• X-rays are required during the procedure so it is important to tell your Gastroenterologist if could be pregnant

• People with diabetes, heart valve disease, cardiac pacemakers, on weight loss drugs (e.g. Ozempic, Wegovy, Mounjaro, Trulicity, Saxenda), or on blood thinning medication e.g. Apixaban, Rivaroxaban, Dabigatran, Warfarin, Clopidogrel, Ticagrelor, Prasugrel (except Aspirin), may require special arrangements, which should be discussed with your Gastroenterologist.

• Arrive at the Endoscopy Unit at the time you are advised. Do not bring any valuables.

• You will be admitted by nurse. After which, your Gastroenterologist and the Anaesthetist will speak with you.

• A rectal suppository (Indomethacin) may need to be administered by the nurse prior to the procedure to reduce the risk of inflammation to the pancreas.

• Deep sedation is administered by an Anaesthetist prior to the procedure so that you remain comfortable.

• X-ray imaging is required to perform the procedure.

• The procedure generally takes around 30-60 minutes to complete.

• After the procedure, you will be taken to the recovery area until the sedation wears off.

• You will usually be allowed to drink fluids once awake, but solids are recommended the following day.

• Your Gastroenterologist will briefly inform you of the findings of your procedure and necessary, a follow-up appointment will be organised to discuss the results in detail.

• Due to the sedation, within the first 24 hours of the procedure, you must AVOID driving, travel alone on public transport or taxi/uber, operate machinery, sign legal documents or consume alcohol. An adult must accompany you home after the procedure and stay with you overnight.

• After 24 hours, you can return to work and resume normal activities.

ERCP is an advanced endoscopic procedure and therefore the risks are higher than a diagnostic endoscopic procedure.

• Mild sore throat and abdominal discomfort are common post-procedure, which usually resolves within an hour.

• For technical reasons, the procedure cannot be successfully completed in 5-10% of cases. In this case, either repeat attempt or alternative procedure may be required.

• Pancreatitis (inflammation of the pancreas) can occur in 3-5% but may be up to 15% in selected patients. If this occurs, then hospital admission will be required.

• Bleeding can occur in 2% of cases and may require blood transfusion or endoscopic treatment.

• Cholangitis (Infection) can occur in 2% of cases.

• Perforation risk is 0.5-1%. Surgery may be required to repair this.

• Like all medical procedures, there is a remote chance that a significant complication can result in death, however this is rare.