Endoscopic Retrograde Cholangiopancreatography (ERCP)

A Diagnostic technique to identify problems of the bile and pancreatic ducts.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts.

Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum. Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.

Why has your doctor requested this test?

Doctors use ERCP to treat problems of the bile and pancreatic ducts. Doctors also use ERCP to diagnose problems of the bile and pancreatic ducts if they expect to treat problems during the procedure. For diagnosis alone, doctors may use noninvasive tests—tests that do not physically enter the body—instead of ERCP.

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Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of

  • gallstones that form in your gallbladder and become stuck in your common bile duct
  • infection
  • acute pancreatitis
  • chronic pancreatitis
  • trauma or surgical complications in your bile or pancreatic ducts
  • pancreatic pseudocysts 
  • tumors or cancers of the bile ducts 
  • tumors or cancers of the pancreas 

What happens during the procedure?

Doctors who have specialized training in ERCP perform this procedure at a hospital or an outpatient center. An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. A health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat. The anesthetic numbs your throat and helps prevent gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible. In some cases, you may receive general anesthesia.

You’ll be asked to lie on an examination table. The doctor will carefully feed the endoscope down your esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During ERCP, the doctor

  • locates the opening where the bile and pancreatic ducts empty into the duodenum
  • slides a thin, flexible tube called a catheter through the endoscope and into the ducts
  • injects a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible on x-rays
  • uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages

The doctor may pass tiny tools through the endoscope to

  • open blocked or narrowed ducts.
  • break up or remove stones.
  • perform a biopsy or remove tumors in the ducts.
  • insert stents—tiny tubes that a doctor leaves in narrowed ducts to hold them open. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.

The procedure usually takes between 1 and 2 hours.

Image courtesy of NEJM

What do you need to do?

You should talk with your doctor about any allergies and medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

  • arthritis medicines 
  • aspirin or medicines that contain aspirin
  • blood thinners 
  • blood pressure medicines 
  • diabetes medicines
  • nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Your doctor may ask you to temporarily stop taking medicines that affect blood clotting or interact with sedatives. You typically receive sedatives during ERCP to help you relax and stay comfortable.

Tell your doctor if you are, or may be, pregnant. If you are pregnant and need ERCP to treat a problem, the doctor performing the procedure may make changes to protect the fetus from x-rays. Research has found that ERCP is generally safe during pregnancy.

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after ERCP, as the sedatives or anesthesia used during the procedure needs time to wear off. You will need to make plans for getting a ride home after ERCP.

Don’t eat, drink, smoke, or chew gum

To see your upper GI tract clearly, you doctor will most likely ask you not to eat, drink, smoke, or chew gum during the 8 hours before ERCP.

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