CALAMBA DOCTORS’ COLLEGE

Virborough Subdivision, Barangay Parian, Calamba City, Laguna

Bachelor of Science in Nursing

ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY
(ERCP)

SUBMITTED BY:
Cervantes, Veejay
Evangelista, Ellyza

BSN3A – Group 1
 CALAMBA DOCTORS’ COLLEGE
Virborough Subdivision, Barangay Parian, Calamba City, Laguna
Bachelor of Science in Nursing

Definition
Endoscopic retrograde cholangiopancreatography, or ERCP, is a type of imaging test that
allows healthcare providers to look inside bile ducts and pancreatic ducts which helps in the
diagnosis and treatments regarding problems in the liver, gallbladder, bile ducts, and pancreas.

What Cases Undergo ERCP?

ERCP is used to find the cause of unexplained abdominal pain or yellowing of the skin
and eyes (jaundice). It may be used to get more information if there is presence of pancreatitis or
cancer of the liver, pancreas, or bile ducts. Other things that may be found with ERCP include:
 Blockages or stones in the bile ducts
 Fluid leakage from the bile or pancreatic ducts
 Blockages or narrowing of the pancreatic ducts
 Tumors
 Infection in the bile ducts

How is ERCP Procedure Performed?

It combines X-ray and the use of an endoscope—a long, flexible, lighted tube. The scope
is inserted through the mouth and throat, then down the esophagus, stomach, and the first part of
the small intestine (duodenum). Healthcare provider can view the inside of these organs and
check for problems. Next, a tube will pass through the scope and inject a dye which highlights
the organs on X-ray.

Preparation and Instruction Before the ERCP

Recommendations for ERCP preparation include the following:
 Healthcare provider will explain the procedure and patient can ask questions.
 Patient may be asked to sign a consent form that gives their permission to do the test.
Read the form carefully and ask questions if something is not clear.
 Do not to eat or drink liquids for 8 hours before the procedure. Patient may be given other
instructions about a special diet for 1 to 2 days before the procedure.
 If patient is pregnant or think they could be, tell the healthcare provider.
 Tell healthcare provider of all medicines (prescribed and over-the-counter) and herbal
supplements that are taken.
 CALAMBA DOCTORS’ COLLEGE
Virborough Subdivision, Barangay Parian, Calamba City, Laguna
Bachelor of Science in Nursing

 Tell healthcare provider if there is a history of bleeding disorders or if patient is taking

any blood-thinning medicines (anticoagulants), aspirin, ibuprofen, naproxen, or other
medicines that affect blood clotting. Patient may be told to stop these medicines before
the procedure.
 If patient has a heart valve disease, the healthcare provider may give antibiotics before
the procedure.
 Patient will be awake during the procedure, but a sedative will be given before the
procedure. Depending on the anesthesia used, patient may be completely asleep and not
feel anything.

Health Teaching Before the ERCP

1. Explanation of the Procedure:
Patients should be informed about the purpose of the ERCP, which is to diagnose and
treat conditions affecting the bile ducts, pancreas, and gallbladder.
2. Risks and Benefits:
Discuss potential risks such as pancreatitis, infection, bleeding, or perforation, as well as
the benefits of the procedure in diagnosing or treating their condition.
3. Preparation:
Explain the preparation required before the procedure, which may include fasting for
several hours and possibly using laxatives to cleanse the bowels.
4. Medications:
Instruct the patient about any medications they need to stop taking before the procedure,
especially blood thinners that could increase the risk of bleeding.
5. Consent:
Ensure the patient understands the procedure and its risks and benefits before signing a
consent form.
6. Post-procedure Arrangements:
Discuss transportation arrangements for after the procedure, as patients may be groggy
from sedation.
7. Follow-up:
Inform the patient about the follow-up plan, including when to schedule a follow-up
appointment and what symptoms to watch for after the procedure.

Health Teaching After the ERCP

1. Immediate Recovery:
Patients will likely be monitored closely in a recovery area until they are fully awake and
stable.
 CALAMBA DOCTORS’ COLLEGE
Virborough Subdivision, Barangay Parian, Calamba City, Laguna
Bachelor of Science in Nursing

2. Diet and Activity:

Instruct the patient on any dietary restrictions or activity limitations following the
procedure. They may need to refrain from eating for a period or avoid certain types of
foods.
3. Pain Management:
Discuss pain management strategies, including any prescribed medications for pain relief,
and when to seek medical attention for severe pain.
4. Complications:
Educate the patient about potential complications such as pancreatitis, infection, or
bleeding, and advise them on symptoms to watch for that may indicate a problem.
5. Follow-up Care:
Schedule a follow-up appointment to assess the patient's recovery and discuss any further
treatment or testing that may be needed.
6. Hydration:
Encourage adequate hydration to help flush out any remaining contrast dye used during
the procedure and to prevent dehydration, especially if the patient experienced vomiting
or diarrhea.
7. Contact Information:
Provide contact information for the healthcare team in case the patient has questions or
experiences any complications after discharge.

Advantage(s) of ERCP
A major advantage of ERCP is that it provides detailed and accurate information about
the pancreaticobiliary system that is difficult to diagnose by EUS. It also provides a less invasive
procedure than open surgery for treating several pancreatic diseases.

Disadvantage(s) of ERCP
A major disadvantage of ERCP is the risk of occurrence of complications. This usually
occurs in 5-20% of patients and can vary with the patient, disease, and the type of ERCP
procedure and the treatment modality. Some of the following complications may occur:
 Pancreatitis: This is the most common complication that occurs in ~10% of patients
undergoing ERCP and requires hospitalization.
 Bleeding: This can occur during sphincterotomy, but can usually be controlled by the
surgeon during the ERCP procedure.
 Intestinal Perforation: This can be caused by the endoscope itself while performing
sphincterotomy. The perforation requires surgical intervention to repair.
 CALAMBA DOCTORS’ COLLEGE
Virborough Subdivision, Barangay Parian, Calamba City, Laguna
Bachelor of Science in Nursing

 Infection: This can occur in the biliary and pancreatic ducts following ERCP, especially if
an obstruction is present that cannot be cleared by the ERCP procedure. Treatment
usually involves antibiotics, but may require surgery to clear the obstruction.

Sources
https://my.clevelandclinic.org/health/diagnostics/4951-ercp-endoscopic-retrograde-
cholangiopancreatography
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endoscopic-
retrograde-cholangiopancreatography-ercp