Charina Ann B.

Balaoing

BSN33 Group 2

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY It is a diagnostic and therapeutic procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts. What is upper gastrointestinal (GI) endoscopy? Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenumthe first part of the small intestine. Indications: ERCP is used when it is suspected a persons bile or pancreatic ducts may be narrowed or blocked due to y tumors y gallstones that form in the gallbladder and become stuck in the ducts y inflammation due to trauma or illness, such as pancreatitisinflammation of the pancreas y infection y valves in the ducts, called sphincters, that wont open properly y scarring of the ducts, called sclerosis y pseudocystsaccumulations of fluid and tissue debris y jaundice Preparations for ERCP 1. Written consent will be provided and further explanations will be made. 2. NPO for 8 hours. Smoking and chewing gum are also prohibited during this time. 3. Inform the physician about all health conditions like allergies, heart and lung problems. 4. Tell the health care provider about all medications taken since the patient may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable. *Medications and vitamins that may be restricted before and after ERCP include y nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve) y blood thinners y high blood pressure medication y diabetes medications y antidepressants y dietary supplements 5. After the procedure, dont allow the patient to engage in activities requiring alertness for 12 to 24 hours due to the effect of the sedatives. . How is ERCP performed? (lasts 30minutes to 2 hours)

1. Patients receive a local anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. 2. An intravenous needle is inserted into a vein in the arm if sedatives will be given. Doctors and other medical staff monitor vital signs while patients are sedated. 3. During ERCP, patients lie on their left side on an x-ray table. A mouthpiece is placed to guard the mouth from biting the finger of the doctor or the tube itself. 4. The patient will be instructed to take slow deep breaths and put the chin into your chest. 5. As the tube is inserted to the mouth, the patient will be asked to swallow. 6. The doctor inserts an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted from a small camera attached to the endoscope to a computer screen within the doctors view. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier for the doctor to examine and locate the bile and pancreatic duct. 7. When the doctor locates the duodenal papilla, a blunt tube called a catheter is slid through the endoscope and guided through the papillary opening. Once the catheter is inside the papilla, the doctor injects a dye into the ducts. The dye, also called contrast medium, allows the ducts to be seen on x rays. X rays are then taken to see the ducts and to look for narrowed areas or blockages. *Procedures to treat narrowed areas or blockages can be performed during ERCP. To see the ducts during treatment procedures, the doctor uses x-ray video, also called fluoroscopy. *Special tools guided through the endoscope and into the ducts allow the doctor to open blocked ducts, break up or remove gallstones, remove tumors in the ducts, or insert stents. Stents are plastic or expandable metal tubes that are left in narrowed ducts to restore the flow of bile or pancreatic juice. *A kind of biopsy called brush cytology allows the doctor to remove cells from inside the ducts using a brush that fits through the endoscope. The collected cells are later examined with a microscope for signs of infection or cancer. What are the risks associated with ERCP? Significant risks associated with ERCP include y infection y pancreatitis y allergic reaction to sedatives y excessive bleeding, called hemorrhage y puncture of the GI tract or ducts y tissue damage from radiation exposure y death, in rare circumstances Patients who experience any of the following symptoms after ERCP should contact their health care provider immediately: y swallowing difficulties y throat, chest, or abdominal pain that worsens y vomiting y bloody or dark stool y fever