Nurse's 3-Minute Clinical Reference

ISBN: 1-58255-670-9 | 2nd_Edition

(Print pagebreak 925)

Endoscopic retrograde cholangiopancreatography

Overview
Radiographic examination of the pancreatic ducts and hepatobiliary tree after injection of contrast medium into the duodenal
papilla

Also known as ERCP

Purpose

To evaluate obstructive jaundice

To diagnose cancer of the duodenal papilla, pancreas, and biliary ducts

To locate calculi and stenosis in pancreatic ducts and hepatobiliary tree

Patient preparation

Make sure that the patient has signed an appropriate consent form.

Note and report all allergies.

Administer a sedative as ordered.

Instruct the patient to fast before the study as ordered.

Explain the use of a local anesthetic spray to suppress the gag reflex and the use of a mouth guard to protect the teeth.

Provide reassurance that oral insertion of the endoscope doesn't obstruct breathing and that the patient remains conscious
during the procedure.

Teaching points

Be sure to cover:

the purpose of the study and how it's done

who will perform the study and where

that the study takes 1 to 1½ hours; longer if a procedure such as stent placement is performed

that the patient may have a sore throat for 3 to 4 days after the examination

that belching and passing flatus occur after the test

that avoidance of alcohol and driving is necessary for 24 hours after the study.

Procedure
An I.V. infusion is started.

A local anesthetic and I.V. sedation are administered.

Vital signs, cardiac rhythm, and pulse oximetry are continuously monitored.

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 Nurse's 3-Minute Clinical Reference
ISBN: 1-58255-670-9 | 2nd_Edition

The patient is placed in a left lateral position.

The endoscope is inserted into the mouth and advanced using fluoroscopic guidance, into the stomach and duodenum.

The patient is assisted to the prone position.

An I.V. anticholinergic or glucagon may be administered to decrease GI motility.

A cannula is passed through the biopsy channel of the endoscope, into the duodenal papilla, and into the ampulla of Vater.

Contrast medium is injected.

The pancreatic duct and hepatobiliary tree are visualized.

Rapid-sequence radiographs are taken after each contrast injection.

Tissue specimen or fluid may be aspirated for histologic and cytologic examination.

Therapeutic measures (sphincterectomy, stent placement, stone removal, or balloon dilatation) may be performed before
endoscope withdrawal, as indicated.

After the films have been reviewed the cannula is removed.

Postprocedure care

Withhold food and fluids until the gag reflex returns; resume diet as ordered.

Provide soothing lozenges and warm saline gargles for sore throat.

Monitoring

Vital signs

Cardiac rhythm

Pulse oximetry

Level of consciousness

Abdominal distention and bowel sounds

Adverse drug reactions

Signs and symptoms of:

Perforation

Respiratory depression

Urinary retention

Ascending cholangitis

Pancreatitis

Precautions

Inform the physician about hypersensitivity to iodine, seafood, or iodinated contrast media.

The procedure is contraindicated in:

pregnancy

cuh999 | 137.189.241.45 | 03 February 2023 9:18:18 Utc

 Nurse's 3-Minute Clinical Reference
ISBN: 1-58255-670-9 | 2nd_Edition

stricture or obstruction of the esophagus or duodenum

acute pancreatitis or cholangitis

severe cardiorespiratory disease.

Nursing Alert
Emergency resuscitation equipment and a benzodiazepine and narcotic antagonist should be immediately available during the
test.

Complications

Ascending cholangitis

Pancreatitis

Adverse drug reactions

Cardiac arrhythmias

Perforation of the bowel

Respiratory depression

Interpretation
Normal findings

Duodenal papilla appears as a small red or pale erosion protruding into the lumen.

Pancreatic and hepatobiliary ducts usually join and empty through the duodenal papilla; separate orifices are sometimes
present.

Contrast agent uniformly fills the pancreatic duct, hepatobiliary tree, and gallbladder.

Abnormal results

Hepatobiliary tree tilling defects, strictures, or irregular deviations suggest possible biliary cirrhosis, primary sclerosing
cholangitis, calculi, or cancer of the bile ducts.

Filling defects, strictures, and irregular deviations of pancreatic duct suggest possible pancreatic cysts and pseudocysts,
pancreatic tumors, chronic pancreatitis, pancreatic fibrosis, calculi, or papillary stenosis.

cuh999 | 137.189.241.45 | 03 February 2023 9:18:18 Utc