Thursday, January 21, 2010

ERCP (Endoscopic Retrograde Cholangiopancreatography)

The Society of Gastroenterology Nurses and Associates (SGNA), Inc. distributed this patient education handout back in the mid-1990's and I have always found it to be very useful.  Certainly there are many easily accessed patient education tools about ERCP via the internet, for example this one this one courtesy of the Jackson/Siegelbaum Gastroenterology Group in Camp Hill, PA is especially nice.

Because my copy of the pre-internet ERCP patient information handout distributed by the SGNA is tattered and of poor quality, I'm transcribing this helpful patient education handout below. It's undated, no author listed and lacks a copyright statement. (Today I inquired with Kathleen O'Brien from SGNA via their online support suite chat feature and received no objection to transcribing this information here for the purposes of my blog readers.)

Patient Education:  ERCP (Endoscopic Retrograde CholangioPancreatography)

After careful medical assessment, your doctor has recommended that ERCP be performed for further evaluation and treatment of your condition.  ERCP is a valuable examination of the diagnosis of many diseases of the pancreas, bile ducts, liver and gallbladder.  ERCP allows the doctor to perform necessary treatments such as enlarging a bile duct opening, removing gallstones lodged in the bile duct, inserting a stent (drain) in the duct or taking a biopsy specimen (tiny bit of tissue).

A flexible fiberoptic tube (duodenoscope) is passed through the mouth, esophagus (food tube) and stomach into the duodenum (first part of the small intestine.)  The ampulla (opening where the bile and pancreatic ducts empty into the duodenum) is then identified.  A small plastic tube (cannula) is passed through the duodenoscope into the ampulla. X-ray dye is injected through the cannula into the ducts.  X-rays are then taken to study the ducts.  Any necessary treatments can be performed at this time.

Dentures and eyeglasses must be removed prior to the start of the procedure.  You may prefer to remove contact lenses at this time.

You will be asked to sign a consent form authorizing the doctor to perform the procedure.

Be sure to tell the doctor and the GI nurse if you are allergic to any medicines, x-ray dyes or iodine products.

A needle for intravenous (IV) medicines and fluids will be placed in your arm vein.  Medicine will be injected through the IV needle that will make you sleepy and relaxed.  Your doctor may also spray your throat or ask you to gargle with a numbing medicine.

You will lie on an x-ray table on your left side and  a small plastic mouthpiece will be placed between your teeth.  You will be able to breathe normally.  The doctor will help you to swallow the lubricated flexible duodenoscope tube.  When the tube is present in the duodenum, you will be helped to turn onto your abdomen with your head turned to the right.

During the procedure you may feel some abdominal fullness or bloating due to the air which the doctor puts into the duodenum.  As the X-ray dye is injected into the ducts, you may feel some mild discomfort.  These feelings should be completely tolerable and not painful.

After the duodenoscope is removed, you may be asked to move into various positions so that more X-rays can be taken.

Many people do not recall any of the procedure because of the effect of the medicine. After the procedure you will probably feel drowsy and may sleep for a short time.  After you have rested, the doctor will discuss the findings with you.

If you have any questions please feel free to ask the doctor, the GI nurse, or the technician.

More ERCP factsheets for patients:

"A+" link:  http://www.gastro.org/wmspage.cfm?parm1=860 from the American Gastroenterologic Association
National Institues of Health Factsheet on ERCP

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