Patient perspective: ERCP
by Michael Hunter
"When you have PSC your life seems to be taken over by letters! ERCP, MRCP, LFTs, MRIs and a lot more.
The ERCP is something that a lot of people get worried about. The actual procedure is described in a lot of places on the internet but I would like to share my experiences with you and take you through what happens. I have had four in the last six months and have lost count in how many I have had in total since diagnosis!
The build up to the day can be the worst part but I would suggest that you talk to your consultant in advance and ask for a mild General Anaesthetic (GA). I think I have profopol. I hear that many hospitals just offer a strong sedative but in my experience go for the GA; you can still come out the same day. On my last ERCP I arrived at UCLH at 12.30 on a Monday, went into the procedure room at 15.10 and was on the train home at 18.50!
Anyway, preparations on the day are quite simple. You can't have anything to eat for 6 hours before your appointment, and nothing to drink from 2 hours before. When you are taken in for your appointment, you are booked in by a nurse. If you are having a GA you will have had a pre-op assessment beforehand as well. Booking in is just going through various questions, most of which are covered in the pre-op assessment. You have your weight and height taken for the anaesthetic. Once all of this is done you will get a visit from the anaesthetist who will explain his part in the procedure and make sure that you understand what he will be doing.
The next person will be a registrar or sometimes the consultant - they will talk you through the procedure explaining any possible risks. These are very small so nothing for me to worry about. You will then be asked to sign a consent form which confirms you understand about the procedure.
When the room is ready, you will be taken through. What amazed me the first time is the number of people present just for your procedure. When I have mine done there is the registrar and the consultant, there are two radiographers, normally two nurses and the anaesthetist. I think there may be one or two more people as well.
You have your details checked and then a canula is put in, you will have a blood pressure cuff put on and the necessary connections to check your heart rate during the procedure. You are then asked to adopt what I now call the "superman" position. Half on your side, right arm forward left arm behind your back. Your right arm is supported in a cradle. You will then have a guide put in your mouth. This nothing to worry about; it just makes sure that the endoscope doesn't catch on your teeth and mouth.
Once this is in I know that I will be out for the count very soon. This is when they administer the anaesthetic - once this starts, you are gone! The next thing I normally remember is waking up in the recovery room where the nurses keep an eye on you. Once you are back you can have a drink after 2 hours and are allowed to eat after 4 hours as long as you don't have any pain. There is sometimes a feeling of being uncomfortable as they do have to put air inside you for the procedure, so it feels a bit like wind. I am normally allowed to leave after I have had a drink and I feel OK.
During the procedure they will normally give you IV antibiotics and a suppository to help protect against possible pancreatitis. You can't drive or sign any important documents for 24 hours afterwards and I normally start a 5 day course of ciprofloxacin when I get home.
The ERCP is not as bad as some people fear.
If you ask for a GA, you will know nothing about the procedure; if you have a sedative then you may feel some discomfort. For me now it is always a GA.
I hope this helps those that haven't yet had an ERCP. I know how you feel but I am now an old hand, I still don't look forward to them but I now know what to expect."