ERCP – Endoscopic Retrograde Cholangiopancreatography


Endoscopic retrograde cholangiopancreatography, or ERCP, is an endoscopic exam in which dye is injected into the duct systems of the liver and/or pancreas. The exam is similar to a cardiac (heart) catheterization in that x-rays are taken once the dye is injected to show the outline of the ducts. The bile and pancreatic ducts empty into the early portion of the small bowel (duodenum), which your doctor reaches by passing an endoscope via your mouth and stomach once you are adequately sedated.


The reasons for doing the tests are many, but ERCP is most helpful for diagnosing and treating disorders of the liver, gallbladder and pancreas. The liver produces bile, which flows down the biliary ducts or gets store in the gallbladder. The bile duct empties into the part of the small intestine known as the duodenum. The pancreas is an organ that makes digestive enzymes, which flow from the pancreas through the pancreatic duct. The pancreatic duct also empties into the duodenum, in the same place the bile duct empties into the duodenum. Both bile and pancreatic enzymes are needed for digestion. ERCP is useful in diagnosing or treating diseases causing blockage of either of these duct systems, and diseases affecting the liver and pancreas. Gallstones, inflammation, tumors, or infection can cause these diseases. ERCP can also be helpful in finding causes of upper abdominal pain, yellow jaundice and pancreatitis.


An ERCP is done in a special hospital procedure room equipped with x-ray machines. In this procedure, a nurse, an endoscopic technician and an x-ray technician assist the physician. The patient’s throat is anesthetized and the patient receives sedation medications intravenously. An endoscope is then inserted via the patient’s mouth and passed into the duodenum. Special catheters and instruments are passed through the scope and used to inject the dye into the biliary and pancreatic ducts as x-rays are taken. If a gallstone is found in the duct, it may be possible to remove it. A tiny cut may be made inside the duodenum to assist with stone removal. If a stricture or narrowed area of a duct is encountered, a stent may be placed to open or dilate it. A stent is either plastic or metal and looks like a tiny straw. If a tumor or mass is seen, biopsies may be taken. The exam usually takes 20-60 minutes, after which the patient is taken to the recovery area.


ERCP is a safe exam when performed by a specially trained endoscopist, however, as with any medical or surgical procedure, there are potential risks or side effects. Serious complications are rare. The most common complication of ERCP is pancreatitis (inflammation of the pancreas). This can occur in 5-15 percent of cases. It results in abdominal pain, and may require hospitalization. Other specific complications, which are much less common can include, bleeding, infection, or perforation. Your doctor can discuss appropriate indications, preparation, and alternative testing before performing an ERCP.