What is this information about?

This information is about a procedure called an ERCP. ERCP stands for endoscopic retrograde cholangio-pancreatography.  

An ERCP allows the endoscopist to examine your bile duct or pancreas with a camera on a thin, flexible tube. X-rays can show if there are any abnormalities or blockages. If anything is found, it can be treated at the same time.  

Why have I been given this information?

Please read this information carefully. It has been given to you because it contains important instructions for you to follow before you come to hospital for the ERCP.  

It also tells you what to expect during and after the procedure, as well as any possible risks and benefits.

What happens during an ERCP?

Your vital signs will be checked before and during the procedure. These are things like your blood pressure and heart rate. 

You are given:

• A local anaesthetic numbing spray to your throat. 
• Sedation. We use “conscious sedation”, not a general anaesthetic. You may be aware of the procedure as it is happening. It should make you feel relaxed and drowsy, but you may still be able to hear and understand what is being said to you. 
• Pain relief.  

You will be asked to lie flat on your front, with one arm facing forward and one facing backwards, your head to the right side. A plastic mouth guard will be placed in your mouth. 

Then a flexible camera tube, called an endoscope, is carefully passed into your mouth, down your gullet, through your stomach and into the beginning of the small intestine (duodenum). 

Your endoscopist will ask you to swallow, to allow the endoscope to pass into your oesophagus. It may cause you to cough or gag. We will use suction to remove any saliva from your mouth. 

By using the endoscope, the doctor can examine the opening of the bile duct.  

A small plastic tube will be passed down the endoscope into this opening (called the papilla) and x-ray contrast (dye) will be injected into the bile ducts. This allows x-ray pictures to be taken. The number of x-rays you receive will be strictly controlled for your safety. 

To see the lining of the stomach and duodenum, air will be gently blown through the endoscope. This can sometimes feel a little uncomfortable, giving you a bloated feeling. 

If a gallstone (or some other blockage) is found, it can be treated 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 information. 

If we are removing gallstones, you may feel some pain when the gallstones are pulled out of the duct. We can give you additional pain relief during the procedure if you need it and it is safe to do so.

How do I prepare for my procedure?

What should I bring with me to the unit?

• A list of all your medications and any allergies.
• Your reading glasses, if needed.
• Wear loose and comfortable clothing. If possible, wear a wireless bra.

Do not bring any valuables with you.

Can I park at the hospital?

Parking space at the Royal Sussex County Hospital is very limited, so please allow plenty of time for your appointment and be prepared to wait in the car park queue.  

Your escort may drop you off at the Millenium Wing and then return to the unit later, to collect you.

What happens when I arrive in reception for my ERCP?

Our receptionist will check you in and ask you to take a seat in the waiting room.

Your appointment time is an arrival time and is not the time of your procedure.

• Some procedures may take longer than others, so we ask for your patience.
• You will be called through to the admissions area by a member of staff. They will ask you some questions about your medical history and your medication.
• We will insert a cannula (thin tube) into a vein in your hand or arm so that we can give you sedation and pain relief during your procedure.
• We may need to do a finger prick test to check how quickly your blood clots. This test is called an INR test and is especially important if you take any blood thinners.
• You will be asked to sign a consent form by the endoscopist before the procedure. Please see an example copy of the form at the back of this booklet.

Please make sure that you give us your escort contact details, so we can call them when you are ready to be collected.  

If you have any questions or if there is anything you do not understand, please do not hesitate to ask.

What happens after my procedure?

You will be taken into the recovery area and will be given time to rest.  

• The nurses will frequently check your vital signs.
• You will remain in the recovery area for a minimum of 4 hours after the procedure.
• You will not be able to eat or drink anything for at least 2 hours after the procedure.
• For 48 hours after the procedure, you must only have a very light, soft diet that is low in fat. 

Before you leave the unit, you will be given a discharge letter with an explanation of the findings and instructions about what to do after the procedure. Your GP will also receive a copy of the report.

Because I have had sedation, is there anything I should avoid after the procedure?

What are the benefits of having an ERCP?

If the x-rays show a gallstone or a blockage, it will be treated immediately in one of these ways: 

1. Endoscopic sphincterotomy. This procedure will often be carried out to help with access into the bile duct and to treat anything found there. It involves cutting the opening of the bile duct (sphincterotomy), using an electrically heated wire (diathermy) which you should not feel. Any stones can then be removed or can be 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 or metal tube called a stent) inside the bile duct to help the bile drain into the intestine in the normal way. This may be removed at a later date. 

3. Spyglass Cholangioscopy. This procedure is done when a gallstone is too big to remove in the usual way, or when there is a narrowing or blockage in the bile duct that needs to be seen directly and have a tissue sample (biopsy) taken.  

A small camera called a spyglass is passed through the endoscope into the bile duct. This lets the doctor see the area clearly, take a biopsy (a small tissue sample), or break up the stone using shockwaves (lithotripsy).

Once the stone is broken into smaller pieces, they are removed from the bile duct and will pass into the bowel naturally. The biopsy sample is sent to the laboratory for analysis. 

Are there any significant risks?

This treatment for bile duct stones and blockages is simpler and safer than surgery. 

However, you should be aware that it is not always successful and sometimes problems can still happen.  

• Bleeding happens in about 1 to 2% of patients who have an endoscopic sphincterotomy. This may come from the cut into the bile duct. If bleeding does happen, it will usually stop within 24 hours. On rare occasions, it may require further treatment.  
• There is a 1% risk of a small tear in the gut lining caused by the camera or the sphincterotomy. This usually heals with supportive care but in rare cases may need an operation. 
• Up to 5% of patients may develop pancreatitis. This is a painful inflammation or irritation of the pancreas. This will usually stop after a few days. Very rarely, pancreatitis can be life threatening and may need an operation.  
• We will usually give you a medication called Diclofenac as a suppository before the procedure to help prevent pancreatitis. Please speak to the doctor or nurse performing your procedure if you have any concerns. 
• There is a risk of infection, called cholangitis, after any ERCP. The risk is increased when spyglass cholangioscopy is used, because of the instruments that are placed in the bile ducts. To reduce this risk, you may be given antibiotics after the procedure.

Frequently asked questions

Will it hurt?

Endoscopic examinations and procedures can be uncomfortable, so we have different ways to make it more comfortable for you.  

You will be given sedation and pain relief through the cannula in your hand or arm, before and during your ERCP. Please let us know if you are uncomfortable in any way and we will do our best to help you.  

After the procedure you may have a sore throat and bloating. These effects should disappear after a few days. When you go home, you will be given written aftercare advice about what to do if your symptoms do not get better.  

How long will it take?

This depends. A simple examination should take between 15 and 30 minutes. A more complicated procedure, involving endoscopic treatment, can take from 30 minutes to 90 minutes. At times this may be longer. 

Your recovery time may also vary depending on what treatment you have been given. You will remain in the recovery area for 4 hours after your procedure. 

When will I get my results?

The biopsy results take up to 8 weeks to come back from the laboratory. The findings are reviewed by your consultant, who will then either arrange an appointment to see you or inform you of the findings in a letter explaining your results. 

Please do not call our recovery area during this time because we cannot give any biopsy results over the telephone. If you have not heard anything after 8 weeks, and you are worried, please contact your GP, who will be informed of your results. 

What do I do if I need to cancel or change my appointment?

Your comments and suggestions

If you have any concerns about your treatment or care, please bring them to our attention. We will do our best to help.

If you feel you would like some support with raising your concerns, the Patient’s Advocate is available to speak on your behalf. You can contact the Patient’s Advocate by telephone between 10am and 4pm on:

Email: [email protected] for either site.

We always welcome new ideas and suggestions. Please let us know if you feel there are ways in which we could improve our service.

At the end of the leaflet is an example of the form ‘Patient agreement to investigation or treatment’. Please print off the PDF version to obtain the example form.

Who can I speak to for more information and advice?

This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.

The information here is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.

Today’s research is tomorrow’s treatments. That’s why UHSx is proud to be a research-active Trust. Find out how you can get involved.  

Visit our website www.uhsussex.nhs.uk/research-and-innovation/information-for-patients-and-public or scan the QR code: