Endoscopy Retrograde Cholangiopancreatography (ERCP)

Gastroenterologists perform endoscopic retrograde cholangiopancreatography (ERCP) to diagnose and treat problems found in the ducts of the pancreas and gallbladder. Pancreatic ducts and bile ducts are tube structures that carry fluids in the digestive system to help break down food.

ERCP is most commonly used to diagnose or treat patients who may have a narrowed or blocked pancreatic duct or bile duct due to:

  • Gallstones
  • Tumors
  • Infection
  • Pancreatitis or other inflammations due to illness or trauma
  • Scarring known as sclerosis
  • Buildup of tissue or debris

ERCP can also be used to monitor chronic jaundice, to get a tissue sample or to insert a drain.

ERCP combines the use of a lighted scope called an endoscope and X-rays to examine the pancreatic ducts and bile ducts. In instances where an abnormal growth or an obstruction is found in the ducts, instruments are inserted through the endoscope to biopsy tissue or open up the blockage.

Preparing for an ERCP

A gastroenterologist will provide you with instructions on how to prepare for ERCP.

It is important that the upper GI tract is empty prior to your ERCP. Eating and drinking is not permitted eight hours prior to the procedure. You should also tell your physician what medications you are currently taking; particularly those that affect blood clotting or interact with sedatives.

Certain medications should be discontinued prior to the procedure. Check with your doctor to review your medications:

  • Anti-inflammatory drugs such as aspirin, ibuprofen and naproxen
  • Blood thinners
  • High blood pressure medication
  • Diabetes medications
  • Antidepressants
  • Dietary supplements

Since ERCP requires you to take a sedative, driving is not permitted for 12 to 24 hours following the procedure. You should make arrangements to have someone drive you home following the ERCP.

What Happens During an ERCP?

ERCP is performed at a hospital or an outpatient surgery center by a trained gastroenterologist and a team of nurses and technicians.

You will receive an anesthetic that is either gargled or sprayed that helps to numb the throat. The anesthetic will also help to eliminate the gag reflex. You are then given a sedative through an intravenous (IV) in your arm. You will then be asked to either lie on your back or on your left side on an X-ray table.

The gastroenterologists will insert a lubricated endoscope into your mouth and then advanced into your esophagus and slowly navigate through the stomach and into the first section of the small intestine (the duodenum) until they reach the point where the pancreatic and bile ducts drain into the duodenum (the papilla). You will then be turned over onto your abdomen.

A catheter is inserted into the papilla and a solution called contrast material is injected to help visualize the bile duct or pancreatic duct while X-rays are taken.

Medical instruments may be inserted through the catheter to collect samples or stents may be placed to open up a blockage found in the pancreatic duct and bile duct. If a gallstone is found during the ERCP, the gastroenterologist may be able to remove it.

Once the gastroenterologist completes the ERCP, the endoscope is removed slowly, and you are brought to the recovery room.

What Happens After an ERCP?

ERCP typically takes 30 to 60 minutes to complete. Following the ERCP procedure, you will be in recovery for 1 to 2 hours.

The X-ray pictures taken during the ERCP to examine the pancreatic and bile ducts will be reviewed.

If you feel any of the following symptoms, contact your physician immediately:

  • Nausea or vomiting
  • New or increased belly pain
  • Fever or chills
  • Dizziness
  • Shortness of breath

In most cases, patients are able to return to their normal activities following the ERCP procedure. Your gastroenterologist can answer any questions you may have regarding eating and resumption of normal activities.

Your gastroenterologist may talk to you about your test and any findings immediately following the ERCP, or they may ask you to call the next day for your results. Biopsy results may take a few days.