SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 34 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission WHA T T E S T S A R E N E E D E D B E F OR E E R C P ? As already mentioned, ERCP is not used to make the diagnosis, only to carry out a procedure once it has been decided what is necessary to do. When a patient is admitted with symptoms suggesting bile duct blockage (jaundice and or abdominal pain, or sometimes just pain) then an abdominal ultrasound is usually carried out first. This is a good test to see if the bile ducts in the liver are dilated, suggesting blockage further downstream, and to look to see if the gallbladder has stones in it. It is not a good test for looking at deeper structures such as the pancreas or the bottom of the bile duct, particularly in larger patients. Magnetic Resonance Cholangio-Pancreatography (or MRCP ) is an MRI scan to look specifically at the bile ducts and the pancreatic ducts. It is the best way to look for stones in the bile duct (marked by the red arrow on the right, below), but does not look at the pancreas itself, so if a tumour is suspected, or a stricture is seen, then a CT scan of the abdome n is necessary (see below, on left). Blood tests are useful to help with the diagnosis of bile duct blockage, but tests to assess the patients clotting screen (INR and platelet count) are mandatory in the 48 hours prior to ERCP. Vitamin K is a vitamin absorbed from the gut in fat, and is essential for the synthesis of some clotting factors. It therefore needs bile to be present in the gut (to absorb the fat and therefore the vitamin K), so if the bile duct is blocked for a significant period of time then clotting becomes deranged due to Vitamin K deficiency. All patients who have been jaundiced for a while need to have their blood clotting checked, and IV Vitamin K given if 8