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.

What are 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 do doctors use ERCP?

Doctors use ERCP to treat problems of the bile and pancreatic ducts. Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of

• Gall stones that form in your gallbladder and become stuck in your common bile duct
• 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

How do I prepare for ERCP?

Talk with your doctor!

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

• Aspirin or medicines that contain aspirin
• Arthritis medicines
• Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
• Blood thinners
• Diabetes medicines

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.

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.

How do doctors perform ERCP?

Doctors who have specialized training in ERCP perform this procedure at a hospital.. 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 most often takes between 1 and 2 hours.

What should I expect after ERCP?

After ERCP, you can expect the following:

• You will most often stay at the hospital or outpatient center for 1 to 2 hours after the procedure so the sedation or anesthesia can wear off. In some cases, you may need to stay overnight in the hospital after ERCP.
• You may have bloating or nausea for a short time after the procedure.
• You can go back to a normal diet once your swallowing has returned to normal.
• You should rest at home for the remainder of the day.

If the doctor performed a biopsy, a pathologist will examine the biopsy tissue. Biopsy results take a few days or longer to come back.

What are the risks of ERCP?

The risks of ERCP include complications such as the following:

• Pancreatitis
• Infection of the bile ducts or gallbladder
• An abnormal reaction to the sedative, including respiratory or cardiac problems
• Excessive bleeding, called hemorrhage
• Perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into it
• Tissue damage from x-ray exposure
• Death, although this complication is rare

Research has found that these complications occur in about 5 to 10 percent of ERCP procedures.2 People with complications often need treatment at a hospital.

Seek care right away

If you have any of the following symptoms after ERCP, seek medical attention right away:

• Bloody or black, tar-colored stool
• Chest pain
• Fever
• Problems breathing
• Problems swallowing or throat pain that gets worse
• Vomiting—particularly if your vomit is bloody or looks like coffee grounds