SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 37 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission So what are the risks that are discussed? It may be useful to know what we discuss with the patients during the consent process in case they have any supplementary questions. I would recommend that you ask to sit in with a patient being consented to see for yourself. Broadly these are: • Failure of planned procedure • Bleeding • Pancreatitis • Perforation • Infection Failure of planned procedure Although not technically a risk, I always tell my patients there is a chance (I usually say around 5% - sometimes more, sometimes less, depending on what is necessary) the procedure may not go as planned, and that failure to complete the ERCP is something they should be prepared could happen. This may be for anatomical reasons (sometimes there may be a large diverticulum, or unexpected pathology causing the duodenum to be narrowed, such as ulcers, or the ampulla may be a strange shape) or for technical reasons (sometimes it’s just not possible to cannulate the ampulla, or to find a way through a stricture). Some patients react differently to the sedatives we use and may not be able to tolerate the procedure at all. A procedure may be partially completed (for example most stones will be removed, but not all) requiring a further ERCP on another occasion. Bleeding There is about a 1% chance of bleeding as a result of cutting through the sphincter muscles at the bottom of the bile duct (more about this technique later). Usually this is minor and can be dealt with at the time of the procedure (again, more later). It is important to remind patients after the procedure that bleeding can be a risk for up to a week, and to let their doctor know if they pass black stools (melaena) or feel unwell. Very rarely, patients have to be admitted for further intervention to stop bleeding following ERCP. 11