What is ERCP?

ERCP or Endoscopic Cholangiopancreatography is a procedure by which a flexible, lighted

fiberoptic tube is passed through the esophagus (swallowing tube), stomach, and finally into the
duodenum (first section of small intestine leading from the stomach). A small plastic tube
(cannula) is passed through a tiny muscular opening (sphincter) that leads into the pancreatic and
common bile ducts. Dye is injected through the cannula and x-rays are taken in order to study the
ductal systems of the pancreas, bile ducts, liver, or gallbladder, depending upon which is being
evaluated.

If anything unusual is seen during the procedure, a biopsy (small sample of tissue) can be
obtained via the scope and sent to the laboratory for further evaluation. Biopsies are taken for
many reasons and do not necessarily imply cancer

PRE -NURSING CONSIDERATIONS FOR PATIENTS UNDERGOING ENDOSCOPIC

RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

 Explain the procedure to reassure patient and significant others, and give chance to ask
questions before written consent is obtained.
 Inform the patient to have diet and/or medication restrictions the week before the ERCP
test. Please ask the physician for detailed instructions. Ask the patient to let the physician
know if have taken any type of blood thinning medication.
 Educate the patient that any heavy meal is not allowed for at least 8 hours before the
procedure, light meals or opaque liquids for 6 hours before, or clear liquids for at least 2
hours before.
 Ask the patient to plan to take the day off from work and have a friend or family member
to bring the patient home after the examination. This is because the medications used for
sedation can impair reflexes, judgment, and ability to drive (similar to the effects of
alcohol).
 Assess patient’s allergies (such as latex) and all current medications have taken since a
significant number of drugs are used during ERCP and drug sensitivities must be known.
In some cases, the doctor may prescribe an antibiotic before the procedure.
 Obtain history regarding any previous exposure to X-ray dyes.
 In some cases, when patients need certain therapeutic interventions during an ERCP
procedure, they may be admitted to the hospital overnight for observation.
 If pregnant, the ERCP should be postponed until after delivery if possible, but if the
procedure is urgent, it can be done safely during pregnancy.
 Assist patient to change into a gown.
 For safety reasons, ask patient to remove eyeglasses or contact lenses, dentures, and body
piercings.
 Before the procedure begins, patient may be given local anaesthetic (a numbing spray
applied onto the throat or gargled) as ordered by the doctor.
 NURSING CONSIDERATIONS DURING AN ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY (ERCP)

 Ask the patient to remain still, relax and comfortable

 Ask the patient to confirm name, date of birth, and the procedure will be conducted.
 On a special table, position the patient on the left side, prone, or supine.
 Start an intravenous (IV) line to administer medications. Medications will be given
through the IV line during the procedure.
 Provide a plastic mouth guard and placed it between the teeth to prevent damage to the
teeth and endoscope.

POST-NURSING CONSIDERATIONS FOR PATIENTS WHO HAVE UNDERGONE

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)

 After ERCP, the patient may experience discomforts such as soreness of throat. Giving
the patient with salt water to gargle is highly recommended.
 Having enough rest will help during the recovery period, so refrain the post op patient
from engaging on extraneous activities or household chores.
 Encourage the patient to drink plenty of fluids according to the doctor’s prescribed
amount. In most cases, a clear liquid diet is prescribed upon discharge. Through this type
of diet nausea can be prevented by starting with a light diet until the post op patient is
advised to take a full diet.
 Bloating can be experienced by the patient, which can cause discomfort. Providing a
heating pad on the belly of the patient can help reduce the discomfort. Encourage patient
to belch and burp if he/she can.
 Educate patient and significant others about the restriction of alcohol and smoking.
 Watch out for the different danger signs that the patient may manifests which require a
refer-back to the doctor:
 new severe, sharp, or steady pain in your stomach, neck, or chest
 fever over 100º F
 vomiting of blood (red or brown in color)
 bowel movements turn black, which can be a sign of bleeding
 lightheaded or dizziness when standing
 shortness of breath or trouble breathing
 Advise patient that within 24 hours after the procedure he or she MUST NOT:
 Drive a car or take public transport unaccompanied
 Operate machinery
 Consume alcohol
 Sign any legal documents or make any responsible decisions
 Remind patient regarding discharge instructions, such as:
  Advising patient not to take any aspirin based analgesia
 Educating patient regarding the medications that can be used for alleviating
discomforts such as Panadol and Nurofen.
 Advising patient to have someone in the house with him or her until he or she feels
recovered.
 Advising patient to ensure adequate fluid intake to remain hydrated.
References:
JCsupport. (2017, June 20). Caring for a Patient Post ERCP. ERCP Malpractice Attorney.
https://ercpmalpractice.com/caring-patient-post-ercp/
Tingali, MD, PhD, A., & Loperfido, MD, S. (2021, December 15). UpToDate.
Www.uptodate.com. https://www.uptodate.com/contents/ercp-endoscopic-retrograde-
cholangiopancreatography-beyond-the-basics