00732 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)

Name of the Procedure:

Anesthesia for Upper Gastrointestinal Endoscopic Procedures (Endoscopic Retrograde Cholangiopancreatography or ERCP)

Summary

Anesthesia for ERCP is used to sedate or anesthetize a patient during a specialized endoscopic procedure that examines and treats problems in the liver, gallbladder, bile ducts, and pancreas. During ERCP, a flexible endoscope is introduced proximally to the duodenum and can provide visual as well as therapeutic treatment.

Purpose

ERCP is primarily used to diagnose and treat conditions of the bile ducts, gallbladder, and pancreas. The goals include locating and managing bile duct obstructions, gallstones, inflamed or scarred ducts, and detecting or treating certain types of cancers.

Indications

• Jaundice or abnormal liver function tests.
• Chronic pancreatitis or unexplained pancreatic disease.
• Bile duct stones or strictures.
• Suspected bile duct or pancreatic tumors.
• Persistent upper abdominal pain or gallbladder issues.

Preparation

• Patients are usually required to fast for 6-8 hours before the procedure.
• Medication adjustments may be necessary, particularly blood thinners or diabetic medications.
• Diagnostic tests such as blood work or imaging scans may be required for planning.

Procedure Description

1. The patient is positioned on their side.
2. Monitors are placed to keep track of vital signs.
3. An anesthesiologist administers anesthesia, which could be general or sedation, depending on the patient's needs.
4. A flexible endoscope is introduced through the mouth, passing through the stomach into the duodenum.
5. The endoscope is guided to the bile and pancreatic ducts, where X-ray dye may be injected to visualize blockages or abnormalities.
6. Therapeutic interventions like stone removal or stenting can be performed if necessary.
7. The endoscope is then carefully removed.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

ERCP is performed in a hospital, specifically in a dedicated endoscopy suite equipped with radiographic capabilities.

Personnel

• Gastroenterologist: Conducts the ERCP.
• Anesthesiologist: Manages anesthesia and monitors the patient.
• Endoscopy nurses and technicians: Assist with the procedure and patient care.

Risks and Complications

• Common: Sore throat, bloating, mild discomfort.
• Rare: Pancreatitis, infection, bleeding, perforation of the gastrointestinal tract, adverse reactions to anesthesia.

Benefits

• Accurate diagnosis and immediate treatment of biliary and pancreatic conditions.
• Relief of symptoms like jaundice and abdominal pain.
• Avoiding more invasive surgical procedures.

Recovery

• Patients may feel drowsy or groggy post-procedure and spend a few hours in recovery.
• Mild throat discomfort is usual.
• Normal activities can typically be resumed the next day, but patients should avoid driving or operating heavy machinery until the anesthesia effects have completely worn off.
• Follow-up appointments are necessary to monitor recovery and address any findings.

Alternatives

• Magnetic Resonance Cholangiopancreatography (MRCP): Less invasive, no therapeutic capability.
• Percutaneous Transhepatic Cholangiography (PTC): More invasive, involves needle insertion.
• Surgery: Reserved for cases where endoscopic treatment is not feasible.

Patient Experience

Patients may feel groggy or disoriented from anesthesia and might have a sore throat. Anxiety about the procedure is common but mitigated by sedation. Pain management involves local anesthetics for the throat and possibly pain relievers post-procedure. Overall, the patient can expect minimal discomfort and a relatively quick recovery.