SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 29 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission I N T RODU C T I ON What is ERCP? ERCP stands for Endoscopic Retrograde Cholangio-Pancreatography, which means it is an endoscopic procedure (ie one that goes through an existing body orifice) to examine and take pictures of the bile ducts (and sometimes the pancreatic duct) retrogradely (ie upstream to the flow of bile or pancreatic fluid). It was invented in the 1960’s and it’s not a very accurate term as these days there are better ways of looking at these ducts (eg MRI scans), and we usually try to avoid the pancreatic duct altogether. ERCP is a term that has survived throughout this time and everyone knows what is meant by it. Why is it done? When there is a suspicion that the bile duct may be blocked, or if a patient presents with pancreatitis, which could be caused by blockage of the pancreatic duct (more later) then a diagnostic procedure is required to accurately diagnose what the problem may be. This is usually an MRI or a CT scan which are painless and relatively safe. ERCP is an invasive procedure and so is only carried out once the problem has been diagnosed and ERCP is thought necessary to solve it. This is termed a therapeutic procedure. Because ERCP carries risks inherent to the procedure, the decision to carry it out is carefully evaluated beforehand. How is it done? The bile duct and the pancreatic duct enter the side of the duodenum about 10cm after the stomach through a single opening called the ampulla. The ampulla is not usually visible with a normal endoscope that looks forward, and so a side-viewing scope (or duodenoscope) is used, and is adapted to allow instruments to be passed through the side of it. What’s the point of this book? ERCP is part of the field known as Advanced Therapeutic Endoscopy, which also includes stenting procedures, removal of large polyps, EUS and more. More and more complex procedures are being carried out endoscopically, and patients are getting older and more frail. I have been learning these procedures for twenty years, and it became obvious that as the procedures become more complex, the role of the assistant is becoming more vital as well. The book is an effort to answer questions I have been asked by you, as well as things I think are interesting or useful to know as you assist with these intricate and delicate procedures, sometimes for hours! 3