Endoscopic Retrograde Cholangiopancreatography

WHAT YOU SHOULD KNOW:

Endoscopic (end-o-SKOP-ik) retrograde (REH-trow-grade) cholangiopancreatography (ko-LAN-g-o-pan-kree-uh-TOG-ruh-fee) (ERCP) is both a test and a way to treat some conditions. Endoscopic means using a tiny scope to look at something inside your body. Retrograde means going backward. Cholangio is the medical word for an area where juices from several organs go into your intestine to help you digest (break down and use) food. Pancreatography means taking a picture of your pancreas.

During an ERCP, a thin tube with a tiny light and camera near the end, is put in your mouth. It goes down your throat and into your esophagus (swallowing tube). Then the tube goes into your stomach and through your stomach to your small intestine. A smaller tube can go inside the tube you swallowed. This even tinier tube can go into the narrow areas your caregiver wants to examine or work on.

ERCP as a test:

ERCP is a test that may be used to:

• See several areas of your digestive system. Sometimes all a caregiver needs to do is to see the area to know what is causing your belly problem.
  
  
• Inject a dye to take pictures.
  
  
• Take a small piece of tissue for a biopsy (BI-op-c).
  
  
• Measure pressures in the ducts (little tubes used to move digestive juices).

ERCP as a treatment:

ERCP is a treatment that may be used to:

• Place a stent. A stent is a plastic or metal object that is used to keep a duct open.
  
  
• Make an opening so a digestive juice will flow evenly from a duct.
  
  
• Break and remove small stones that may be clogging ducts.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• With an ERCP you may get an infection in your digestive system. You may also get pancreatitis (inflammation of the pancreas). You may bleed, or get a hole in your esophagus (swallowing tube), stomach, or intestine. You may have trouble breathing or stop breathing. You may need surgery to fix some of these problems, or need to stay in the hospital because of them. You may even die.
  
  
• Without ERCP you may need to have another test, which also has risks. You may need surgery. Surgery has many more risks than ERCP.

WHILE YOU ARE HERE:

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Gown:

A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Pre-op Care:

• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• X-ray: These are pictures of your digestive system. If you had an earlier barium test, caregivers may do an x-ray to make sure all of the barium is gone from your body.

During Your ERCP:

• An IV will be started to give you fluids and medicine. You will be awake for the ERCP, but you will be given medicine to make you drowsy. You need to be awake enough to help your caregivers. There will be times when you will be asked to move. There will be other times when you will be asked to lie very still. Your throat will be sprayed with a numbing medicine. This medicine will help you not feel the tube as it goes through your mouth and down your throat. The thin tube that is used for ERCP will not keep you from breathing normally. Your caregiver may put a brace in your mouth to keep it open. They do this because you will find it hard to feel your lips, mouth, and throat are when they are numb.
  
  
• You may be placed on your back or on your left side, and a lead shield may be put over your throat. You may feel bloated as the tube moves through your esophagus (swallowing tube), stomach, and into your intestine. The bloating is from air used to move the thin tube along quickly. An ERCP usually takes about an hour.

After Your ERCP:

• You will be taken to a room where you will be carefully watched. Your blood pressure will be taken often. You will still be sleepy.
  
  
• You may have cramps in your belly. The cramps will go away when you eat something later in the day.
  
  
• You will be given water when you can feel your throat again.
  
  
• You may be hoarse and your throat may be sore from the tube for several days. Throat lozenges may help. You may also try gargling with warm salt water.