SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 65 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Post-ERCP pancreatitis As mentioned in earlier chapters, this occurs approximately 1 time per hundred ERCP’s and becomes obvious in the vast majority of cases within 4 hours of the procedure. It is related to certain procedures, dehydration, prolonged ERCP, repeated cannulation or injection of contrast into the PD, but in my experience most often happens after fairly simple and straightforward procedures. All patients should be given a non-steroidal anti-inflammatory suppository before the ERCP unless there are specific contraindications, as the evidence shows that this will reduce the incidence of post-ERCP pancreatitis by about 50%. The patient will complain of pain and decline eating or drinking, usually within 30 minutes of the procedure but sometimes a bit longer. Abdominal discomfort is not uncommon after ERCP and may be due to bloating as a large amount of air is passed into the small bowel particularly in prolonged procedures. Some patients may have sensitive bile ducts which start to ache as the analgesia given during the procedure starts to wear off, so it may be difficult to know which patient has developed pancreatitis, but the avoidance of food is almost absolute in patients with pancreatitis so if they accept a sandwich and keep it down, they probably don’t have it. If in doubt, ask the operator to come and see the patient. Treatment is with IV fluids, IV paracetamol and sometimes the need for IV Morphine. The patient should be reviewed by medical staff. If the patient does not recover within an hour or two then further review and admission to hospital is required. In rare (about 1 in 10,000) cases post-ERCP pancreatitis can be fatal, and most cases of moderate or severe pancreatitis will spend several days if not weeks in hospital. Perforation This is very rare and it’s usually obvious that a hole in the lower CBD or duodenum has formed. Sometimes air can be seen surrounding the kidney on the Xray, and can even track under the skin to cause neck and facial swelling during the procedure (surgical emphysema). In these cases a FCSEMS is placed as quickly as possible into the CBD and care is taken to avoid blowing air down the endoscope which could pass through the hole. The patient is admitted and placed NBM to prevent further fluids or food from leaking out of the duodenum, given IV fluids and antibiotics. Sometimes a feeding tube is necessary. Patients typically spend a few weeks in hospital, and occasionally require surgery. 3 9