SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 38 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Pancreatitis Post ERCP pancreatitis is pain arising from inflammation of the pancreas. It occurs as a result of the pancreatic duct becoming occluded even temporarily, or by damage to the pancreatic duct during ERCP by passing a wire into the body of the pancreas or forcefully injecting contrast into the pancreatic duct. It occurs about 2% of the time after ERCP. It is a short self limiting process in the majority of the time, and mostly occurs within 6 hours of the procedure (in practice most occur within an hour or two). In most cases the patient will feel sick and complain of abdominal pain requiring analgesia and observation overnight, but will recover fully and go home within a day or two. In rare cases the patient has to be admitted for longer, and in exceptional cases (1 in 10,000 is the usual quoted figure) the pancreatitis can be fatal. Diclofenac 100mg (or equivalent) given rectally as a suppository has been shown to halve the risk of pancreatitis and should be given as a matter of routine prior to ERCP unless there are very well documented reasons not to. Perforation Perforation of the duodenum or bile ducts as a result of ERCP is very rare (I quote less than 1%) but not unheard of. It can be so mild that it is only discovered by accident (subclinical) or severe and life threatening and requiring emergency intervention. Those patients may require intravenous nutrition for some weeks (TPN) or even surgery to repair the defect. Infection This is unusual and mostly occurs in predictable circumstances - either when infection is already taking place in the bile ducts (cholangitis) or if a blocked bile duct can not be drained after contrast has already been injected. In these cases the patient will be prescribed antibiotics during or after the ERCP. Spontaneous infection after ERCP does occur but so rarely that routine prophylaxis with antibiotics is not recommended. 12