ERCP Consent 📸
Consent guide for ERCP (endoscopic retrograde cholangiopancreatography). Procedure explanation, risks, benefits, alternatives, and patient information for obtaining informed consent.
🔍 Procedure
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – a procedure using an endoscope and X-rays to diagnose and treat bile and pancreatic duct problems.
💡 Indications
- Suspected bile duct stones, strictures, leaks, or malignancy.
- Pancreatic or biliary obstruction.
- Abnormal imaging or liver/pancreatic tests requiring ductal evaluation.
📌 Preparation
- No food for 6 hours before the procedure. Clear fluids may be taken up to 2 hours before.
- Remove dentures, glasses, hearing aids, jewellery, contact lenses before the procedure.
- Tell your doctor about any allergies (especially to contrast or iodine), medications, or if you are pregnant.
- You may be asked to stop or adjust blood thinners or diabetes medications before the procedure.
🧾 Procedure Walkthrough
- You will lie on your side. A cannula is inserted for sedation and monitoring.
- Throat spray and sedatives are administered. You may be drowsy but not fully unconscious.
- A mouthguard protects your teeth.
- The endoscope is passed through your mouth to the duodenum.
- Dye is injected into the bile or pancreatic ducts, and X-rays are taken.
- Possible treatments include sphincterotomy, stone removal, or stenting.
- You will be monitored in recovery. Most people go home the same day.
⚠️ Risks & Complications
- Pancreatitis (~5%): inflammation of the pancreas; usually mild but may require hospitalisation. Rarely severe, needing surgery or ICU.
- Bleeding (2–3%): often related to sphincterotomy; typically managed during the procedure. Higher risk with blood thinners.
- Infection (2–3%): including cholangitis or aspiration pneumonia, especially if fasting or sedation precautions aren’t followed.
- Failure (~5%): the procedure may be incomplete, requiring repeat ERCP or alternative approach.
- Sedation-related issues (0.2–0.5%): heart or lung problems, especially in the elderly or in emergencies. Rare allergic reactions or anaphylaxis.
- Perforation (<1%): a tear in the gut lining; may settle with conservative treatment but can require surgery.
- Missed pathology: small risk of missing stones or strictures even in expert hands.
- Other rare risks: contrast allergy, phlebitis at cannula site, radiation exposure, hospital-acquired infections.
- Very rare: death (<0.01%).
- If complications occur, emergency treatments such as surgery, radiology, or transfusion may be required.
- Risks of not proceeding: persistent symptoms, worsening jaundice, infection, or pancreatitis.
✅ Benefits
- Treats bile duct stones, strictures, leaks, and tumours directly.
- May avoid need for major surgery.
- Can relieve jaundice and prevent infection or pancreatitis.
🔄 Alternatives
- MRCP – non-invasive imaging, diagnosis only.
- PTC – needle-guided drainage through the liver.
- Surgical exploration of ducts.
- Observation or supportive care if appropriate.
🧠 Special Considerations
- Interpreter available if needed.
- Trainees may observe, assist or perform the procedure under supervision.
- Separate consent required for photo, video, or audio recording.
- You may withdraw consent at any time.
- Emergency treatment permission may be included to manage unexpected complications.
🗣️ Example Consent Script
- "We’re recommending an ERCP to examine and possibly treat your bile or pancreatic ducts using a camera and X-rays."
- "You’ll be sedated and we’ll pass a flexible tube through your mouth to take images and perform treatment if needed."
- "Risks include pancreatitis, bleeding, infection, or very rarely perforation or death."
- "We may need to perform emergency treatment if complications arise. You may withdraw your consent any time."
- "Do you have any questions or concerns before we proceed?"