ERCP-examination

(Endoscopic Retrograde cholangiopancreaticography)
Information leaflet on an examination of the biliary system and the pancreatic duct

Introduction
ERCP-examination is a procedure for examining your biliary system and your pancreatic duct.
An ERCP-examination is performed if there are problems with either your biliary system or your pancreas.
In this examination, a flexible viewing tube with a lens and light attached (an endoscope) is passed, via the mouth through the oesophagus and the stomach into the duodenum (the upper part of the small intestine). A catheter (a fine tube ) is then inserted into the endoscope so that a contrast fluid (radiopaque contrast medium) can be carried to the ducts. After this, X-Ray photographs will be taken in order to detect any abnormalities or gallstones.

An E.R.C.P examination is performed by a specially-trained internist or by gastroenterologist together with a radiologist.

A = Oesophagus B = Stomach C = Liver D = Small intestine  E = Colon Pancreas: not visible: lies behind stomach/colon.

Preparation at home

• if the examination is to be performed in the morning, you must not eat or drink anything after the previous midnight (00.00 hours).
• if the examination is to be performed in the afternoon, you are allowed to eat a light breakfast (white bread and/or a rusk with tea or coffee) until 08.00 hours.
• wear comfortable clothes; no tight - fitting garments, no bra, no metal buttons/studs/zip-fasteners
• to be on the safe side, bring night clothing and your sponge bag (toiletries) with you.

Attention! Before you come to the hospital, arrange transport home. You must not drive yourself, ride a bicycle or use public transport unaccompanied. During the examination, it may be necessary to remove a small piece of tissue (biopsy) or to perform another procedure. You must, therefore, not take any blood-thinning medicines before the examination. You should tell the doctor, who is dealing with your case, if you are taking Fenpro-coumon (Marcoumar), Acenocoumarol (Sintrommitis), APS, Aspirin, Ascal, Asprobruis, Diclofenac or Naprosyne.

How long does the examination take?
The examination takes about 45 minutes with a post-operative check-up after two hours, depending on the treatment you have had.

Preparation in the hospital

• you must go to the "Short Stay" department on the 3rd floor (North lift), where you will be made ready for the examination. During the preparation, an infusion needle will be inserted in your hand or arm.
• a hospital porter will take you to the X-Ray department where the examination will take place.

The examinaton

• you will be given a drink that will stop the "foaming" of the gastric juices.
• your throat will be locally anaesthetised with a spray to stop you retching.
• if you have false teeth, they should be taken out before the examination.
• an adhesive plaster will be stuck on one of your fingers in order to check your heartbeat and breathing during the examination; if it becomes necessary, you will be given extra oxygen.
• you will be asked to lie on your stomach on the examination table.
• you will be given a plastic ring between your teeth to protect both your teeth and the endoscope.
• to induce sleepiness you will be injected with an opiate through the infusion needle.
• during the the examination you will be asleep.
• the doctor or nurse will give you instructions and explain how you should swallow the tube - some discomfort may be felt as it passes down your throat; even though you have been given an opiate.
• air will be passed through the tube during the examination this may make you want to belch.

After the examination
You will be taken to the "Short Stay" Department where you will be monitored for two hours. Your throat may be somewhat sore following the examination.
You may also feel full of wind. This is due to the air that was blown into your stomach during the examination. Releasing wind (belching) will help to relieve this feeling.
After the removal of gallstones, you will have to remain 24 hours for observation in the hospital. This is because there is always a small chance that complications, such as bleeding or a local infection, may arise from the examination.

Complications
Complications occur very rarely. However, if you do have bad stomach-ache or develop a fever after the examination, you should immediately contact your Specialist and, after 17.00 hours, the Accident and Emergency (Spoedeisende Hulp) Department of our hospital.
Telephone number: 070 - 312 44 45.

The results
The doctor, who performed the examination, will not generally be able to give you your results immediately. He has to wait about a week for the results of the tissue examination and the X-Rays. He will then pass on this information to your specialist.

Tell your doctor if you are allergic to any particular medicines if you suffer from any form of respiratory disease if you are pregnant

Finally
If you do have any more questions, please ask them before the examination as, whilst you are being examined, talking is difficult.