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Endoscopic Retrograde Cholangiopancreatography

(ERCP)

Pronounced: en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee
by Daus Mahnke, MD

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is used to treat and diagnose problems in the liver, gallbladder, bile ducts, and pancreas. ERCP uses endoscopy and x-rays. An endoscopy is the use of a special scope with a camera to view your throat, stomach, and upper intestine.

Liver and Gallbladder

AC00035-nl_gallbladder and liver.jpg
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

This procedure may be done if you are suspected of having:

  • Blockage of the bile duct
  • Blockage of the pancreatic duct
  • A leaky duct
  • Irritation of the pancreas or liver

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have an ERCP, your doctor will review a list of possible complications, which may include:

  • Damage to the esophagus, stomach, small intestine, or bile duct
  • Pancreatitis
  • Infection
  • Bleeding

Some factors that may increase the risk of complications include:

  • History of problems with ERCP
  • Bleeding disorders
  • Abnormal anatomy
  • Pregnancy
  • Poor overall health

What to Expect    TOP

Prior to Procedure

  • Do not eat for 8-12 hours before the procedure.
  • If you have diabetes, discuss your medicines with your doctor.
  • Arrange for transportation after the procedure. You should not drive for 24 hours after the procedure.
  • Inform your doctor if you have had previous allergic reactions to contrast material.

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:

  • Anti-inflammatory drugs such as ibuprofen
  • Blood thinners
  • Anti-platelet medications

Anesthesia

  • Your throat may be sprayed with a medicine to make it numb.
  • You will be given IV medicine to help you relax.
  • If your doctor thinks your ERCP will take a long time, you may have general anesthesia. You will be asleep.

Description of the Procedure

You will lie on your stomach with your head turned to the right. A mouthpiece will be placed in your mouth to help keep it open. Your breathing and heart rate will be monitored. An endoscope will be put into your mouth. The scope will be slowly passed through your throat into your esophagus, stomach, and/or small intestine/duodenum. Air will be passed through the scope to open the small intestine/duodenum to see better.

The images will be viewed on a video monitor. The scope will be passed into the place where the ducts from the liver and pancreas open into the small intestine.

A tiny tube from the endoscope will then be passed into the opening of the bile and pancreatic ducts. A contrast material will be injected through this tube. The contrast will make the ducts visible on the x-ray. If a gallstone shows up on the images, it may be removed through the scope. Scarring or narrowing within the ducts can also be treated with instruments passed through the scope. Stents may be placed to keep the duct open. Tissue samples may also be taken through the scope for biopsy. The sample will be sent to a lab for further testing.

How Long Will It Take?

It will take 30 minutes to two hours.

Will It Hurt?

During the procedure, you may feel discomfort in your throat. After the procedure, your throat may be sore for a few days. In addition, you may feel bloated and need to belch.

Average Hospital Stay

If the ERCP is diagnostic, you may go home the same day. If you have other procedures done through the scope, you may need to stay in the hospital overnight.

Postoperative Care

At the Care Center

You will be observed in a recovery area for at least one hour before you are sent home.

At Home

Be sure to follow your doctor's instructions, which may include:

  • Do not drive for at least 24 hours.
  • Rest the remainder of the day.
  • Resume your normal diet, unless told otherwise by your doctor.
  • Do not drink alcohol for 24 hours after your procedure.
  • If you were asked to stop taking certain medications, ask your doctor when to resume taking them.

Call Your Doctor If Any of the Following Occurs    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Nausea and/or vomiting or vomiting blood
  • Severe abdominal pain
  • Black, tar-like stools or bloody stools

In case of an emergency, call for medical help right away.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org
American Society for Gastrointestinal Endoscopy
http://www.asge.org

CANADIAN RESOURCES:

Canadian Digestive Health Foundation
http://www.cdhf.ca
HealthLink BC
http://www.healthlinkbc.ca

References:


Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health State-of-the-Science Conference Statement: ERCP for diagnosis and therapy, January 14-16, 2002. Gastrointest Endosc . 2002 Dec;56(6):803-809.
ERCP (endoscopic retrograde cholangiopancreatography). National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/. Updated June 29, 2012. Accessed May 30, 2013.
Therapeutic ERCP. American Society for Gastrointestinal Endoscopy website. Available at: http://www.asge.org/patients/patients.aspx?id=398. Accessed May 30, 2013.
Last reviewed May 2013 by Daus Mahnke, MD; Michael Woods, MD
Last Updated: 5/30/2013