Endoscopic Procedures

CHOLANGIOPANCREATOGRAM (ERCP)

ERCP is an endoscopic procedure to examine the biliary and pancreatic system. ERCP will only be advised after other less invasive tests have been performed and failed to provide a clear diagnosis or when intervention is planned, i.e removal of bile duct stones or relieving blockage of the bile duct.
Stones in the bile duct can lead to severe infection of the liver and bile duct or inflammation of the pancreas, therefore it needs to be removed. Blockages can be benign or cancerous and can often be temporarily relieved by passage of a plastic or a metal stent.

PREPARATION

You need to fast from midnight the day prior to your planned procedure.
You current medications may need to be adjusted or ceased. Please inform your doctor if you are taking aspirin, blood thinners, Vitamin E, fish oil, non-­‐steroidal anti-­‐ inflammatories or insulin. It is essential to alert your doctor if you have any allergies to any medications including iodine and shellfish.
You will need to arrange for someone to drive you home after your procedure given you will be sedated during the procedure. Sedatives will affect your judgement and reflexes for the rest of the day. Therefore, you should not drive, operate machinery or carry out tasks which require decision making until the next day.

THE PROCEDURE

At the beginning of the procedure your throat will be sprayed with local anaesthetic and you will be given an injection of sedative agents into your vein to make you sleepy. You will be given oxygen to breathe during the procedure.
You will then be positioned in a prone position for the procedure. The procedure will take at least 30 minutes to an hour to complete. (Please inform the staff if you have any major neck or back problems that may require special attention during the procedure.)
Once you are asleep, the endoscope is passed from the mouth into the stomach and first part of the small intestine. In the small intestine, a small opening known as the
‘ampulla’ is identified. We then introduce a small plastic tube into the opening to gain access into the bile duct. Dye (iodine contrast) is injected and X-­‐rays are taken during the procedure. Based on the X-­‐ray findings during the procedure, a small cut to the opening, known as ‘sphincterotomy’ may be performed to enlarge the opening.
In 10% of patients, it is not possible to pass the plastic tube into the appropriate ducts. This may be related to anatomical reason, a tight blockage or failure to identify the opening. In this circumstance, your doctor will usually inform you about alternative options to treat the problem.

AFTERWARDS

You will be monitored in the recovery area for 3‐4 hours until the effects of the sedatives have worn off. You may experience a sore throat for two to three days.
You will be restarted on a clear fluid diet in the recovery area and you will need to stay on a clear fluid diet for the rest of the day. You may resume a normal diet the next day.
Your doctor will inform you of your test results prior to discharge.
If you develop a fever, abdominal or chest pain, vomiting, passage of black stool or any other concerning symptoms after you leave hospital, you should immediately return to the hospital or contact your doctor. Complications are less severe if treated early and usually develop within 24 hours of the procedure.

ENDOSCOPIC ULTRASOUND (EUS)

EUS is an endoscopic procedure to examine the internal organs that lie next to the gastrointestinal tract. It provides detailed pictures of major organs in your chest, liver, gallbladder, bile duct and pancreas.
EUS will only be advised after less invasive tests have been performed and are inconclusive or if a sample to tissue (biopsy) is required for diagnosis.

PREPARATION

You need to fast from midnight the day prior to your planned procedure.
You current medications may need to be adjusted or ceased. Please inform your doctor if you are taking aspirin, blood thinners, Vitamin E, fish oil, non-­‐steroidal anti-­‐ inflammatories or insulin. It is essential to alert your doctor if you have any allergies to any medications.
You will need to arrange for someone to drive you home after your procedure given you will be sedated during the procedure. Sedatives will affect your judgement and reflexes for the rest of the day. Therefore, you should not drive, operate machinery or carry out any task which requires clear thinking until the next day.

THE PROCEDURE

At the beginning of the procedure your throat will be sprayed with local anaesthetic and you will be given an injection of sedative agents into your vein to make you sleepy. You will be given oxygen to breathe during the procedure.
You will then be moved to a left lateral position for the procedure. The procedure will take at least 30 to 45 minutes to complete. (Please inform the staff if you have any major neck or back problems that may require special attention during the procedure.)
Once you are asleep, a thin, long, flexible tube with a small camera attached at the tip of the scope is passed from the mouth into the stomach and first part of the small intestine. This allows the doctor to see pictures of the inside and outside of your gut on a video screen. EUS also allows a fine needle biopsy to be taken during the procedure.

AFTERWARDS

You will be monitored in the recovery area for at least 1-­‐2 hours until the effects of the sedatives have worn off. You may experience a sore throat for two to three days.
If fine needle biopsy was performed, you will be started on a clear fluid diet in the recovery area and you will need to stay on a clear fluid diet for the rest of the day. If you only had an endoscopic ultrasound without biopsy done, you may resume a normal diet.
Your doctor will inform you of your test results prior to discharge.
If you develop a fever, abdominal or chest pain, vomiting, passage of black stool or any other concerning symptoms after you leave hospital, you should immediately return to the hospital or contact your doctor. Complications are less severe if treated early and usually develop within 24 hours of the procedure.

GASTROSCOPY

This procedure involves an endoscope – a long, thin flexible tube with a ‘video camera’ at the tip – being passed through the mouth into the oesophagus, stomach and first part of the small bowel. It allows the doctor to inspect these areas as well as perform specialised procedures such as biopsies. A gastroscopy is performed as day surgery in hospital.

PREPARATION

An empty stomach is essential for a safe and accurate examination, so you should have nothing to eat or drink, including water, for approximately six hours before the examination. Your doctor will provide more specific details about this, depending on the time of day that your test is scheduled.
Tell your doctor in advance about any medications you take. You might need to adjust your usual dose for the examination – this is particularly important if you have diabetes. Discuss any allergies to medications, and medical conditions such as heart or lung disease.

THE PROCEDURE

Before the procedure a light anaesthetic (sedative) is usually given – you will not receive a full general anaesthetic. You may be slightly aware of what is going on in the room, but generally you won’t remember anything. The back of your throat may be sprayed with local anaesthetic to make it numb, and a small mouthguard may be put between your teeth to stop you from biting the endoscope. If you have false teeth (dentures) they will be removed before the procedure. The doctor and medical staff monitor your vital signs during the procedure and will attempt to make you as comfortable as possible.
The procedure takes about 15 to 30 minutes.
Once sedated and lying in a comfortable position on your left side, the endoscope is passed through the mouth and then in turn through the oesophagus, stomach and duodenum. The tube is just less than one centimetre in diameter and does not enter your windpipe, so it won’t interfere with breathing. A small camera in the end of the scope transmits a video image to a monitor, allowing the doctor to carefully examine the lining of your upper GI tract.

AFTERWARDS

You will be monitored in the recovery area until most of the effects of the sedation medication have worn off. Your throat might be a little sore, and you might feel bloated because of the air introduced into your
stomach during the test. You will be able to eat after you leave unless your doctor instructs you otherwise.
In most circumstances your doctor will briefly inform you of your test results on the day of the procedure. A follow-up appointment may be made to discuss the test results more fully. The results of any biopsies or samples taken will take several days.
Because of the sedation given it is very important that you do not drive a car, travel on public transport alone, operate machinery, sign legal documents or drink alcohol on the same day after the test. It is strongly advised that a friend or relative take you home and stay with you.
Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.