ERCP: Comprehensive Procedural Protocol and Guidelines

Pre-Procedure Requirements

Patient Preparation

• NPO for 8 hours prior to procedure
• Review patient's coagulation status
• Obtain informed consent
• Document allergies, especially to iodine contrast
• Review current medications, particularly anticoagulants

Equipment Checklist

• Duodenoscope with appropriate accessories
• Fluoroscopy unit
• Contrast media
• Various sizes of cannulation catheters
• Sphincterotomes
• Guide wires (0.025", 0.035")
• Stone extraction balloons/baskets
• Stents if indicated

Procedure Steps

1. Initial Setup

• Position patient in prone or left lateral position
• Administer appropriate sedation/anesthesia
• Place bite block
• Connect monitoring devices

2. Scope Insertion and Navigation

1. Insert duodenoscope through oropharynx
2. Advance to second portion of duodenum
3. Identify ampulla of Vater
4. Position scope in short position

3. Cannulation Technique

1. Select appropriate cannulation device
2. Align device with papillary orifice
3. Advance wire/catheter using controlled movements
4. Confirm position with fluoroscopy

4. Diagnostic/Therapeutic Interventions

• Obtain cholangiogram/pancreatogram as indicated
• Perform sphincterotomy if needed
• Extract stones/place stents as required
• Document findings

Post-Procedure Protocol

Immediate Care

• Monitor vital signs
• Assess for complications
• Document procedure details

Follow-up Instructions

• Resume oral intake as appropriate
• Monitor for delayed complications
• Schedule follow-up appointment

Quality Metrics

• Technical success rate
• Complication rates
• Patient satisfaction scores

Documentation Requirements

1. Procedure indication
2. Technical details
3. Findings and interventions
4. Complications if any
5. Follow-up plan