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Home | Articles | Admission | Elective Admission – ERCP

Elective Admission – ERCP

Last updated 14th May 2021

ERCP elective lists are performed on a Thursday pm.

Ensure a complete clerk in is done including

  1. Past medical history – cardiac/ respiratory disease, prosthetic valves, gastric surgery
  2. Social history (patients who scores >9 on FAST score would need to be on IV Pabrinex (3 ampules TDS for 3 days) + GMAWS protocol)
  3. Recent illness – chest infections, jaundice, fever
  4. Fill out Post ERCP pancreatitis prevention checklist located in ERCP care pathway

Bloods

  1. IV access (dorsum of right hand only unless contraindicated)
  2. FBC, U&E, LFT (within 2 months), INR (checked on morning of admission in SSU)
  3. If INR >1.5 and/or Bilirubin >100, at least 2 doses of Vit K 10mg IV given OD over 2 days
  4. Request amylase for day after procedure

HEPMA

  1. Suspend any potential nephrotoxics prior to operation – including NSAIDs, ACEi. Prescribe all medications on HEPMA and then suspend these to reduce errors.
  2. Antiplatelets
    • Aspirin – suspend on day of surgery
    • Clopidogrel should be stopped 7 days prior to procedure
  3.  Anticoagulants
    • Warfarin – stopped 5 days prior to procedure
    • DOAC – stopped 48 hours prior to procedure
  4. Unless contraindicated (Hx of peripheral arterial disease), all patients should be prescribed TED stockings

Other Information

  1. A copy of the referral form should be filed in the patient’s notes, if not please contact Mr. Apollos’ Secretary, Lyndsay Guttridge on extension 33765
  2. Consent for ERCP ± sphincterotomy ± stent placement will be obtained by the endoscopist in the Unit.
  3. Prophylactic antibiotic (Gentamicin) is given in the Interventional Suite peri procedure.
  4. In the event of a failed ERCP with an un-drained Biliary tree, antibiotic should be continued and patients should be prescribed Ciprofloxacin 500mg BD oral
  5. Post procedure, you may be contacted to prescribe Voltarol 100mg suppositories PR for selected cases which must be done ASAP.

Complications

    1. The patient can expect a sore throat which will respond to paracetamol
    2. There is a 3% risk of pancreatitis due to manipulation near the pancreas.
    3. If a sphincterotomy is performed, there is a 2% risk of haemorrhage and a 1% risk of retroperitoneal perforation.
    4. The potential mortality, risk is less than 0.5% (if the patient enquires)

Discharge Arrangements

  1. The vast majority of patients go home the following day and follow up plans will be recorded on the ERCP report.
  2. Serum Amylase levels must be checked the following day of the ERCP.
  3. If there are signs of pancreatitis, the patient will be kept in, NBM and on intravenous fluids until the inflammation has settled.