Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that lets your doctor see the bile ducts in your pancreas to check for and treat problems.

ERCP combines upper gastrointestinal (GI) endoscopy and X-ray. Upper GI endoscopy involves having an endoscope (flexible tube) inserted into your mouth so your doctor can see the upper part of your GI system – esophagus, stomach and duodenum (first part of small intestine). The endoscope has a camera in it. Pictures are projected onto monitors so your doctor can see inside you during the procedure.

Why it is Done

You might need ERCP if your doctor needs to:

  • Remove tissue samples for a biopsy
  • Open a blockage in a bile duct caused by a tumor or gallstones in the gallbladder
  • Place a stent (piece of plastic or metal) into a duct to prop open a blocked area

Gallstones found during ERCP can be removed during the procedure.

What to Expect

ERCP takes place at a hospital, surgery center or clinic.

  • Your doctor tells you how to prepare for the procedure. Usually, this means you can't eat or drink for about eight hours beforehand, and you should avoid smoking and taking certain medications.
  • Your doctor numbs your throat with a local anesthetic. This medication is sprayed in your throat or you gargle with it.
  • You also may have a sedative-medication to make you sleepy. This is given through a needle in your arm (IV/intravenous).
  • Your doctor puts an endoscope (flexible tube) in your mouth and passes it down your throat and esophagus to your stomach, duodenum (first part of small intestine) and bile duct.
  • The tube is equipped with a tiny camera. It transmits pictures that your doctor watches on a screen during ERCP to see inside.
  • Your doctor pumps air into your stomach and small intestine through the endoscope to provide better pictures.
  • Your doctor slides a catheter (thin tube) through the endoscope and injects dye to make your ducts more visible on the X-rays. This helps your doctor see any blocked areas in the ducts.
  • If problems are detected, your doctor uses special tools – inserted through the endoscope – to remove cells for testing, open blockages, remove or break up stones, remove tumors or insert stents (plastic or metal tubes prop open blocked areas).
  • After the procedure, you rest in a recovery room while the sedation medication wears off. This can take an hour.
  • You can't drive home if you have had sedation medication. Bring someone with you who can drive.
  • You might feel tired and need to rest for the remainder of the day. You can go back to your normal activities as soon as you feel up to it.
  • Your throat might hurt after ERCP. This lasts only a day or two.

What the Risks Are

Risks of ERCP include:

  • Bleeding
  • Infection
  • Pancreatitis
  • Radiation damage to tissue
  • Puncture of a portion of the gastrointestinal tract or a duct
  • Allergic reaction to the sedative medication

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