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Discipline

: Surgery

Sub Discipline

: Surgery

Document Title

: Procedure Note Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

PROCEDURE DETAILS

Procedure Ordered

Procedure Requested By

Date & Time Of Procedure

From

To

PERFORMING STAFF

Performing Staff

Indication[S]

Please Update Method

PRE-SCOPE HISTORY

Previous Ercp

Findings

Concomitant Medical Conditions

YesNoneNot known

Bronchial Asthma

COAD

Ischemic Heart Disease (IHD)

Hypertension

Diabetes

Inflammatory bowel disease

Vulvular Heart Disease

Prosthetic Cardiac Valve

Cardiac pacer

Immunocompromised

Previous pelvic surgery

Previous colon resection

Haematological disorders

Others, specify

Risk Factors

YesNoneNot known

AntiHCV

Current Medication

YesNoneNot known

Antibiotics

Comments

MEDICATION ADMINISTERED

Premedication

Type

Topical Anaesthetic Spray

Type

Babcon/Simethicone Liquid

Sedation

YesNo

Comments

Anticholenergic

YesNo

Comments

Antidote/ Reversal

YesNo

Comments

Antibiotic Prophylaxis

YesNo

Comments

PROCEDURE REPORT

Image

Endoscopic Findings

Major Papilla

Normal

Oedematous

Bulging

Tumour

Periampullary diverticulum

Previous sphincterotomy

Stenotic

Others, specify

Papillary Secretion

Cannulation

Bile Duct Cannulation

YesNo

Pancreatic Duct Cannulation

YesNo

ERCP findings

Bile Duct

Calibre

Site

Common duct

Right main duct

Left main duct

Hepatic Confluence

Intrahepatic ducts

Cystic duct

Classification

Comments

Gall Bladder

Not opacified

Stones

Sludge

Polyps

Septum

Tumour

Others, specify

Comments

Bile Duct Stone

Number

Site

Common duct

Right main duct

Left main duct

Intrahepatic ducts

Cystic duct

Comments

Other Findings

Sclerosing cholangitis

Choledochal cyst

Post-cholecystectomy

Biliary worm infestation

Others, specify

Comments

Pancreatic Duct

Normal

Dilated

Proximal Stricture

Distal Stricture

Stones

Ductal Ectasia

Pancreatic Divisum

Pancreatitis

Others, specify

Comments

Procedure Performed

Biopsy

YesNo

Sphincterotomy

Type

Size

Comments

Stent Insertion

No Of Stent

No of stent_5448

No of Stent Method

Please Update Method

Stone Extraction

Stone Extraction

Please Update Method

Comments

Biliary Balloon Dilatation

YesNo

Nasobiliary Drain Insertion

YesNo

Complications

Complications

DIAGNOSIS

Endoscopic Impression

Post-procedure Instructions

Recommendations & Follow-Up Plan

SIGNATURES

Notes Component

PROCEDURE DETAILS
PERFORMING STAFF
PRE-SCOPE HISTORY
MEDICATION ADMINISTERED
PROCEDURE REPORT
DIAGNOSIS
SIGNATURES

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