SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 66 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission Tiny perforations caused by a wire or a cannula pushing through the wall of the duodenum during difficult cannulation are quite common and rarely cause any problems, but exceptionally the patients may present a few days later with abdominal pain and fever if the leak has not closed up rapidly. Infection As mentioned before, this occurs when instruments are introduced into a closed off system and drainage is not secured. Prophylactic antibiotics are given, usually as a stat dose IV at the end of the procedure and orally to go home or back to the ward with. A further ERCP or another method of drainage is usually arranged straight away. In EUS this is a similar scenario when a cyst is punctured and fluid aspirated - bacteria can be transferred into the cyst by virtue of the fact that a need has been passed into it and sealed off when it is removed. Infection following a routine, successful ERCP is quite uncommon, although patients with wide bore stents in place can occasionally develop infection from bowel contents refluxing back up into the biliary tree. 4 0