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Endoscopic procedures

Endoscopic procedures are a reliable method of investigating the body’s internal organs. An endoscope is a long, flexible fibre optic tube with a tiny camera and a light on the end.

Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is an endoscopic procedure that helps doctors to see if there are problems with your bile ducts, gallbladder or pancreas. It can show up blockages, whether gallstones are present, narrowing of the bile ducts and tumours. ERCP can also be used in the treatment of gallstones, helping to dislodge, break down and remove them.

The hospital at which you’ll have your ERCP will provide you with guidelines on any preparations you need to make before the procedure, such as how long beforehand you’ll need to stop eating and drinking, and whether it means any possible changes in your medication. At the beginning of the procedure, the doctor will spray the back of your throat with a local anaesthetic to make it feel numb. Sometimes a local anaesthetic lozenge is used, or you will be given a sedative injection through the drip (venflon) in your hand or arm. This will make you drowsy so that it lessens the discomfort of having a tube passed into your gullet. You will be positioned on your side to follow the curvature of your gut. The doctor will ask you to swallow the first section of the endoscope. After this the doctor will push it further down your gullet into your stomach and duodenum. The doctor will look at images on a TV monitor which come from the endoscope’s camera which is filming the procedure.

Air is also passed into the tube into your gut to make it easier to see the lining of the gut. This may make you feel bloated. The endoscope is designed with an attachment down which small instruments and tubes can be passed.

This has many uses:

Contrast dye can be placed into the bile and pancreatic ducts. X-ray pictures are taken immediately after the dye has been given to show up narrowings (strictures), gallstones or tumours pressing on the ducts. A small tissue sample (biopsy) from the lining of the gut can be taken to check for abnormal tissue or cells.  If the X-rays show a gallstone obstructing the bile duct, the doctor can widen the duct by making a cut to let the stone into the duodenum (first section of the small intestine). This is called a sphincterotomy.

If there is a narrowing in the bile duct, the doctor can place a stent to open it up and keep it from collapsing. The stent can remain in place to help to drain away bile into the duodenum. The endoscope is gently pulled out when the procedure is completed. It takes around 30 minutes to one hour, depending on what is done.

Your aftercare will depend on the findings of the ERCP. You might be booked in for an overnight stay if you have received a stent or had gallstones removed. The hospital will also provide you with information when you are discharged that will help with any problems that might arise after an ERCP procedure.