ERCP

/ERCP
ERCP2019-01-08T23:28:11+00:00

PROCEDURE- ERCP

What is this Procedure?

The procedure you will be having is called an Endoscopic Retrograde Cholangio-Pancreatogram or more commonly known as an ERCP

This is an examination of your Bile duct or Pancreatic duct using a flexible endoscopic camera and X-ray dye which allows detailed pictures of the bile duct and / or pancreas.  The instrument used in this investigation is called a duodenoscope.  It is flexible and has a diameter less than that of a little finger.  The duodenoscope allows light to be directed onto the lining of your upper digestive tract and relays pictures back to a screen viewed by the endoscopist. It will allow the endoscopists to view the ampulla which is the gate way for the bile duct and pancreatic duct which drain the liver and pancreas into the first part of the small bowel. By injecting dye into the ampulla, XR images can show images of the bile and the pancreatic duct.

You have been advised to have this investigation to try and find the cause of your symptoms, and to see if you may have a problem in your Bile duct or pancreatic duct. Gallstones or narrowing of the bile duct are common problems and both can cause jaundice (the skin turning yellow) and pain.

ERCP can identify the exact problem and then at the same administer treatment by removing the stone or by passing the blockages with stent.

The procedure will be performed by, a specially trained doctor, a team of specially trained nurses and radiographer will also be present within the X-ray room and we will make the investigation as comfortable as possible for you.  You will be given a local anaesthetic throat spray and also a pain medication and have sedation injected into a vein for this procedure.

Because of the specialist nature of the technique and the specialised equipment needed, the procedure will be performed at the Royal Liverpool Hospital on the Gastroenterology unit where the specialist nursing care and equipment is available. It is a day-case procedure (i.e. you will be admitted and discharged on the same day with no overnight stay). For information and direction please refer to the website www.liverpoolgastroenterology.nhs.uk

Is there an Alternative to this Test?

There are other ways at looking at the bile duct such as an MRCP which you may have already had however these tests cannot be used to treat a problem which an ERCP can. An operation or a procedure called a Percutaneous Transhepatic Cholangiogram  (PTC) may be alternative. But they are associated with more risk than an ERCP. These however need careful discussion with your doctor as not having the test may result in your symptoms becoming worse or the cause of the symptoms remaining unknown.

What are the risks of the procedure?

The healthcare team will try to make your procedure as comfortable as possible. However complications can happen. Some of these can be serious and can on the rare occasion even cause death (risk of serious complications less than 1 in 200).

ERCP is an invasive investigation and therefore has the possibility of associated complications.  These occur extremely infrequently; we wish to draw your attention to them so with this information you can make your decision.

The risks must be compared to the benefit of having the procedure carried out.  The risks can be associated with the procedure itself and with administration of sedation.

The main risks are of mechanical damage to teeth or bridgework; perforation or tear of the lining of the stomach or oesophagus  (risk approximately 1 in 2000) if sphinctertomy performed (risk: 1 in 200) and bleeding (risk: 3 in 100) which could mean you are treated whilst in hospital.  Certain cases may be treated with antibiotics and intravenous fluids or blood products.  Perforation may require surgery to repair the hole.

Infection of the Bile duct (cholangitis) (risk: less than 1 in 100). You will be given oral anti-biotics before and after the investigation to reduce this risk.

Bleeding may occur at the site of biopsy samples but nearly always stops on its own.

Allergic Reaction. Allergic reaction to the equipment, materials or sedative is possible.  The endoscopy team is trained to detect and treat any reactions that might happen.  Let the endoscopist know if you have any allergies or if you have reacted to any drugs or tests in the past.

Sedation. Sedation can occasionally cause problems with breathing, heart rate and blood pressure.  If any of these problems do occur, they are normally short lived.  Careful monitoring by a fully trained endoscopy nurse ensures that any potential problems can be identified and treated rapidly.If there are any concerns about your level of fitness you may be assessed by a doctor before being treated.

Inflammation of the Pancreas (pancreatitis), which causes abdominal pain and nausea (risk: 3 in 100) if occurs usually settles with analgesia within a few days.

Not Being Able to Finish the Procedure, This can happen due to a technical difficulty, food or blockage in the upper digestive system, complications during the procedure or discomfort.  Your doctor may recommend another ERCP or a different test or an operation.

How do I prepare for the test?

  • Prior to the test, the department will arrange some blood test and give you some antibiotics to take before the procedure.
  • Make sure you fast for 6 hours before the test with nothing to eat and drink with the exception of medication – see medication
  • The test is performed as a Day-case. Which means there is no over-night stay in hospital and you have your procedure and discharged on the same day using within 4 hours afterwards
  • You will need an escort to take you home and stay with you overnight
  • Take your medication as normal with a small a thimble cup of water unless you are on any of the medication mentioned below
  • ALLERGIES & WARNINGS: Please notify of any allergies to medication. Please let me know if you are on any blood thinning medication/anticoagulants/anti-platelets or if you are a diabetic (see below)

What about my medication?

If you routinely take medicines please continue to do so. You may take your medication in the morning with a very small amount of water. However, any tablets may need to be stopped due to the increased risk of bleeding

Diabetics

If you are a diabetic controlled on insulin or medication please ensure you inform the doctor before hand and let the endoscopy department is aware so that the appointment time is appropriate.  .

Anticoagulant

Please inform the doctor the unit if you are taking anticoagulants e.g. warfarin / Pradaxa or clopidogrel / Prasugrel/ Dipyridamole (Persantin)/Dipyridamole + Aspirin combined (asasantin Retard)/ Ticagrelor (brilligue)/ Prasugrel (Eficent)/ Acenocoumarol (Sinthrome)/ Phenindione/ Rivaroxaban/ Dabigatran Etexilate (pradaxa)

Implantable pacemaker or internal defibrillator. Please make the department aware as special arrangements will need to be made with ECG prior to the procedure for turning off defibrillator during the exam and switched back on afterwards

Allergies to Medication

Please inform the doctor and the department ahead of time especially if you have had previous reactions to sedation, pain killers or anaesthetics

What happens when I arrive?

You should expect to be in the department for approximately 6-8 hours

You will be met by a qualified nurse who will ensure you understand the procedure and discuss any outstanding concerns or questions you may have.

You will have a brief medical assessment including measurement of blood pressure, heart rate and oxygen levels with a qualified endoscopy nurse who will also check whether there have been any changes to your health since your pre-assessment appointment. This is to ensure that you are still fit enough to have the test.

If you have not already signed the consent form the doctor or nurse will go through the information to check your understanding of the investigation and ask you to sign once any questions have been answered.

Sedation

Routinely the procedure is Intravenous sedation or local anaesthetic throat spray to improve your comfort during the procedure so that the endoscopist can perform the procedure successfully. This is not a general anaesthetic

The throat is numbed with a local anaesthetic spray. This makes it easier for the endoscope to pass through your throat and into the gullet. It may feel that you cannot swallow of you have something stuck in your throat. This is a feeling that the anaesthetic gives you and is quite normal and means the anaesthetic is working.

The sedation will be administered via a small needle (known as a cannula) which will be inserted in the back of your hand or arm through which the medication can be administered.  This will make you more relaxed but not unconscious.  You will be in a state called conscious sedation: this means that, although you may be drowsy, you will still hear what is said to you and will be able to follow instructions during the investigation.  Sedation may make it unlikely that you will remember anything about the procedure.  You will be able to breathe quite normally throughout.

Whilst you are sedated you will be connected by a finger probe to a pulse oximeter which measures your oxygen levels and heart rate and also to a blood pressure monitor to ensure your safety during the procedure.  The nurse will also give you supplementary oxygen which is administered to you via little plastic prongs which are placed in your nostrils.

After your procedure you will need a responsible adult to accompany you home and remain with you for at least 24 hours following the procedure. Also please note that if you decide to have sedation you are not permitted to drive, drink alcohol, operate machinery, sign any legally binding documents or have care of another person for 24 hours.

What should you expect during the Procedure?

The ERCP test usually takes between half an hour and an hour.

On entering the procedure room which is in the XRay Department, the endoscopist and the room nurse will introduce themselves and carry out some safety checks.  If required you will have the opportunity to ask any outstanding questions.

If you have any dentures you will be asked to remove, well fitted dentures can stay in.  A pot to put them in is provided.  Any remaining teeth will be protected by a small plastic mouth guard which will be inserted immediately before the examination commences.

The local anaesthetic throat spray this will be sprayed onto the back of your throat whilst you are sitting up and swallowing, the effect is rapid and you will notice loss of sensation to your tongue and throat.

The nurse looking after you will ask you to lie on your left side and will place an oxygen monitoring probe on your finger. If you are having sedation the nurse will give you supplementary oxygen which is administered to you via little plastic prongs which are placed in your nostrils.

The endoscopist will administer this prior to starting the procedure. The endoscopist will then pass the endoscope into your mouth, down your oesophagus (gullet) then into stomach and duodenum.  Your windpipe is avoided and your breathing will be unhindered.

The procedure can be uncomfortable and you may feel bloated to begin with until the correct position is found. This is because air is blown into your stomach so that this area can be visualised thoroughly.

The endoscope is positioned to look at the papilla. The papilla is a small circle of muscle at the exit of the bile duct that controls the flow of bile / pancreatic enzymes into the intestine (see diagram below). X-ray dye is injected up into the ducts via the papilla to allow for clear X-ray pictures of the ducts.

If there are Gallstones in the bile duct these can usually be removed by  using a sphincerotomy (a small cut / diathermy of the papilla). If there is a blockage in the bile duct then a plastic or metallic tube (stent) can be inserted to allow for drainage of bile.

During the procedure samples may be taken from the lining of your digestive tract, bile duct or pancreatic duct  (this is painless) for analysis in our laboratories.

The samples will be sent to the pathology laboratory or, if required, to other specialist laboratories for analysis.  Small samples of tissue are usually retained indefinitely in the department as part of your medical record.

What happens after the procedure ?

You will be taken from the procedure room to either recovery area in the endoscopy unit. You may immediately be given a pain-killer suppository in the recovery area.

Following sedation you will be allowed to rest for as long as is necessary.  Your blood pressure, heart rate and oxygen levels will be observed and this may require us to administer oxygen to you.  If you are diabetic, your blood glucose will be monitored.  Once you have recovered from the initial effects of any sedation (which normally takes 30 minutes). There may be prolonged period of nothing to eat or drink for 3 hours and then you will be given a glass of water. Provided you have no pain you will be offered a snack and moved into a chair.  As sedation can make you forgetful it is a good idea to have a member of your family or a friend with you when you are given this information although there will be a short written report available.

If you have had sedation you may feel fully alert following the investigation.  However, the drug remains in your blood system for about 24 hours and you can intermittently feel drowsy with lapses in memory.

Before you leave the department the nurse or doctor will explain the findings and any medication or further investigations required.  They will also inform you if you require further appointments.

You will leave the department with a copy of you examination report

Results from biopsies will not be available for up to 2 weeks, so clinic appoints are made 2 weeks after the procedure

What about Fees (Price) of the Test?

Please contact your insurer prior to your admission to inform them of your treatment/tests and confirm this is covered by your policy. You will need to obtain a pre-authorisation number from your insurer for the treatment/tests. In particular, please check whether any top up fee is payable by you, if your insurer does not cover my full fee. Please also check that the hospital’s fees are covered (which are charged in addition to my estimated fee below).

I only charge within accordance/agreement with your insurance company guidelines.  These fees are freely available from your insurance company either by phone or on their website under schedule of fees. You may need the procedure codes for your examination, which are either J3900 & X3510 or. If your company does not have a set schedule of fees for then please contact my secretary and I will let you know the price in advance of the procedure which will be in line with other insurance companies fees.

Fees not included in the estimate

This estimate does not include:

  • Hospital Fees
  • Anaesthetist fees. An anaesthetist is rarely required as the procedure is usually performed with conscious sedation in 99% of cases administered by myself. However, if a general anaesthetic is needed then an anaesthetist will be required, and the anaesthetic fees will be an additional cost and the level of costs will be determined by your anaesthetist.
  • The fees of other consultants. Your treatment/test will involve the services of a [describe the type of consultant/s]. This will be an additional cost and the level of costs will be determined by that consultant. [If you know the name of the other consultant/s, please also include their contact details here and explain that the patient can contact them for information about their fees.]
  • In event of unforeseen complications such as hospital admission
  • Repeat procedure for whatever reason or additional test following on from the findings of this test

For more information contact the Endoscopy Department.

Guidelines for people with diabetes undergoing upper GI endoscopyy (gastroscopy)

Useful Websites

British Society of Gastroenterology
The NHS Website
EIDO Healthcare
Guts UK Charity
Liverpool Gastroenterology

“I was nervous! It was easy – very professional with the right touch of empathy.”

5th July 2019

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“The service I received from Dr Sarkar was excellent. The appointments were conveniant for me. There was sufficient time for me to discuss my concerns and agree to the suggested investigations. The gastroscopy and colonoscopy that I had which were carried out by Dr Sarkar went very smoothly. The service I received was first class.”

28th June 2019

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“From my initial consultation with Dr Sarkar to my endoscopy, I felt assured and relaxed about the procedure (having heard so many disturbing reports from friends). I can only compliment Dr Sarkar for his superb professionalism in every respect. I would never again be afraid if I had to undergo further investigation under his care. The procedure was carried out by Dr Sarkar and his team whilst I was under sedation and was not in any way uncomfortable or caused me any distress. I can only add two words – thank you.”

27th June 2019

Service – ★★★★★
Procedure – ★★★★★

Michael Broom

“Very pleased with treatment. Excellent sedation procedure.”

21st June 2019

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“I have appreciated the very prompt appointment service for both consultation and examinations required. I found all staff, clinical and administrative alike to be pleasant, helpful, friendly and professional. I found no adverse effects and the examinations were both thorough and made as comfortable as possible. I found Dr Sarkar to be of the utmost consideration, skilled and professional. Results were explained thoroughly and clear advice given. I like Dr Sarkar and would consult again if necessary with confidence.”

May 2019

Service – ★★★★★
Procedure – ★★★★★

Anonymous

May 2019

Service – ★★★★★
Procedure – ★★★★★

P E Berger

“Very efficient service and care at the hospital”

May 2019

Service – ★★★★★

Philip Taylor

“Brilliant Service”

Service – ★★★★
Procedure – ★★★★

W Chambers

“Dr Sanchoy Sarkar is a friendly, approachable consultant who gave a good overview of his diagnosis, offered additional details where necessary. He made the procedure itself relaxed and as easy as possible. He was calm, professional and offered explanations throughout the procedure. An excellent all round service. ”

Service – ★★★★★
Procedure – ★★★★★

Victoria Spurole

“Mr Sarkar provided excellent quick consultations. Procedure was quick and painless. Would Highly Recommend. ”

Service – ★★★★★
Procedure – ★★★★★

H Bennet

“Seen on time. Good Communication felt given time to answer questions”

Service – ★★★★★
Procedure – ★★★★★

Mr Williams

“Excellent service for preparation and surgery’”

Service – ★★★★★
Procedure – ★★★★★

Mrs Woan

“I find Dr Sarkar extremely adept at giving you confidence in what he is doing. Explaining where necessary as the procedure proceeds. I cannot believe his expertise could be improved upon. This this my second experience with Dr Sarkar and I appreciate his approach’”

Service – ★★★★★
Procedure – ★★★★★

Kenneth Merrett

“I was treated very courteously by Dr Sarkar and the staff at Spire Liverpool. I am very grateful that my treatment was organized so quickly. Thank you so much Dr Sarkar. I can’t believe how much better I feel after being treated so quickly by the staff at the Royal Hospital.”

Service – ★★★★★
Procedure – ★★★★★

M Pearson

“Dr Sarkar is a terrific professional. He explains all of the issues clearly and sensitivity. I have absolute faith in him. The procedure was very professional and carried out with minimum fuss”

Service – ★★★★★
Procedure – ★★★★★

Anthony Coyne

“The procedure adopted by Dr Sarkar saved me from having to undergo bowel surgery. Skills were immaculate”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“I have rated the overall service as 5 stars because everything was explained exactly what to expect. I was dealt in a professional manor. The procedure was quick and painless with thanks to all who carried out the procedure.”

Service – ★★★★★
Procedure – ★★★★★

S. Chadwick

“Service Excellent. Was able to see the consultant quickly and have the procedure quickly. All the staff was very nice and reassuring. The only minor negative was that I was sent something via email with a secure link and I was not able to open this on my computer so I never read it. Procedure was very comfortable. No negatives to the procedure I experienced, was able to have the procedure quickly with no discomfort Felt Dr Sarkar was very approachable and professional. Thank you”

Service – ★★★★★
Procedure – ★★★★★

Lucy Wigley

“Excellent care. Considerable time taken due to nature of the procedure, diagnosis and anxiety.Procedure- absolutely excellent. Put at ease. Procedure was painless and very little discomfort if any.”

Service – ★★★★★
Procedure – ★★★★★

Veronica Jones

“5 start service and speedy treatment.Consultant Mr Sarkar very professional and puts you at ease. Treatment options and procedure fully explained which helps a great deal at the consultation stage. Would highly recommend Mr Sarkar. Procedure- excellent. Endoscopy suite team were brilliant. Procedure over in 10 minutes. Sedation was great- no recollection of anything. If you have any worries about this procedure, please don’t worry- very safe hands looking after you!”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“Mr Sarkar provided excellent, quick consultations. I would highly recommend.”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“Dr Sarkar was very professional and courteous. I was treated with kindness and sensitivity during a very difficult time.”

Service – ★★★★★

Anonymous

“Very pleased with each visit and resulting diagnosis. Dr Sarkar immediately acted, and very quickly I felt I was getting looked after and I could see light at the end of the tunnel. I couldn’t have been any better looked after.”

26th July 2019

Service – ★★★★★
Procedure – ★★★★★

P. Patterson

“Excellent clarity of consultations. Excellent clarity of explanations before and during procedure.”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“I was nervous! It was easy. Very professional with the right touch of empathy.”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“From my initial consultation with Dr Sarkar to my endoscopy, I felt assured and relaxed about the procedure (having heard so many disturbing reports from friends). I can only compliment Dr Sarkar for his superb professionalism in every respect. I would never again be afraid if I had to undergo further investigation under his care. The procedure was carried out by Dr Sarkar and his team while I was under sedation and was not in any way uncomfortable or caused me any distress. I can only add two words – thank you.”

Service – ★★★★★
Procedure – ★★★★★

M. Broom

“The service I received from Dr Sarkar was excellent. The appointments were conveniant for me. There was sufficient time for me to discuss my concerns and agree to the suggested investigations. The gastroscopy and colonoscopy that I had which were carried out by Dr Sarkar went very smoothly. The service that I received was first class.”

Service – ★★★★★
Procedure – ★★★★★

Anonymous

“Very pleased with treatment. Excellent sedation procedure.”

Service – ★★★★★
Procedure – ★★★★★

Anonymous
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