SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 68 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission T H E E R C P WA S UN S U C C E S S F U L . NOW WHA T ? It depends on what is meant by unsuccessful and why it happened. Sometimes a repeat procedure becomes necessary because stones were not fully removed, and a temporary drainage has been secured with a pigtail stent - in this case the repeat ERCP is not urgent and the patient may be left to recover for 6-8 weeks before repeat ERCP is planned. Oedema causing swelling of the wall of the duodenum and bile ducts is a factor in failure of completion of some ERCP’s and in these cases the procedure may be reattempted in 48 hours or so. When the procedure has been halted due to bleeding it is important to know what the operator has planned, and this should be clear on the report. Please ask if it is not, as the nursing staff on the ward (as well as the patient and their family) should be aware of any further plan. When a stricture can not be stented then percutaneous drainage may be carried out as shown on the Xray images below. Metal stents can be passed through the liver to secure drainage, or sometimes a wire is passed through the skin into the bile ducts and left protruding in to the duodenum. This can be then picked up at ERCP and the CBD cannulated - this is known as a ‘rendez-vous ERCP’ Sometimes the stones are too large to be removed and in these cases a decision is made as to whether the patient will undergo surgery (if they are young and require a cholecystectomy anyway) or if cholangioscopy is indicated. We are fortunate to have set up this system in RGH in 2019, and were the first in Wales to carry it out. It is usually carried out under anaesthetic in theatres, and is beneficial as it saves repeated ERCP, and recovery is much quicker than after open or laparoscopic surgery. 4 2