What is ERCP?

Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized technique used to study the bile ducts, pancreatic duct and sometimes, the gallbladder. Ducts are drainage tubes or channels. The drainage channels from the liver to the intestine are called bile ducts and those from the pancreas to the intestine are called pancreatic ducts.

Why is ERCP done?

ERCP can be used to diagnose problems such as jaundice (yellowing of the skin and eyes), cholangitis (inflammation and/or infection of the bile ducts), pancreatitis (inflammation of the pancreas) and blockage of the bile ducts caused by gallstones or cancer. ERCP can also be used to diagnose and treat malignant (cancerous) and benign (non-cancerous) bile duct and pancreatic duct strictures, or narrowed regions of the duct. Prior to the development of advanced imaging tests such as magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), ERCP was frequently used as a diagnostic procedure to investigate the biliary tree and pancreas. However, ERCP is now mostly used for treatment purposes only.

How is ERCP performed?

During ERCP, your doctor will pass a special type of endoscope through your mouth, esophagus and stomach into the duodenum (first part of the small intestine). An endoscope is a thin, flexible tube with a video camera on the leading end that lets your doctor see inside your digestive tract. After your doctor sees the common opening to the ducts from the liver and pancreas, at the major papilla, your doctor will pass a narrow, plastic tube called a catheter through the endoscope and into the ducts. Your doctor will then inject a contrast material (x-ray dye) into the pancreatic or biliary duct and will take x-rays. These x-ray images help in diagnosis and in performing treatments.

When needed, other procedures can be performed during ERCP such as removal of gallstones, stretching of narrowed areas (strictures), insertion of stents (drainage tubes) and obtaining biopsies (tissue samples).

What preparation is required?

First, let your doctor know about any medical conditions you have, such as heart, lung disease or diabetes. Also, be sure to mention any allergies you have to medications, latex or contrast dye.

Most medications can be continued as usual, but some medications may interfere with the preparation or the examination. Inform your doctor about any medications you are taking, particularly insulin, aspirin products, arthritis medications, anticoagulants (blood thinners, such as warfarin or heparin) and other drugs that interfere with clotting such as clopidogrel (Plavix), apixaban (Eliquis), ticagrelor (Brilinta), dabigatran (Pradaxa) and rivaroxaban (Xarelto).

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink for approximately six hours before the examination. However, a small amount of water or clear liquids is allowed up to two hours beforehand. Your doctor will tell you when you should start fasting, as the timing can vary. In most situations, it would be all right to take your medications on the morning of the procedure with a sip of water, but do remember to check with your doctor. In rare situations, some patients with severe medical conditions may need to obtain medical clearance before the procedure.

What can I expect during ERCP?

For an ERCP examination, you will receive medication to help you relax, make you sleepy and to minimize discomfort. Your doctor might ask an anesthesia specialist to give these medications, sometimes with insertion of a tube into your airway to assist with breathing during general anesthesia. You may start by lying flat on your abdomen. Some doctors employ other positions such as on your side or on your back. Your doctor will pass the endoscope into your mouth and down to your intestine. The endoscope does not interfere with your ability to breathe. The examination generally takes around 60 minutes.

What is a stent?

These are hollow tubes, made from plastic or metal alloys, that help with drainage of the biliary and pancreatic ducts. Sometimes, they are used to treat strictures (narrowed regions) in the ducts. Unlike heart stents, plastic stents can become blocked over time and are not permanent. Less often, metal stents can be placed. They are larger and tend to remain open longer, but are typically only used in certain situations. Some metal stents are removable and others are permanent. Your doctor will visit with you about the correct type of stent suitable for your situation and will let you know when or if the stent needs to be removed or replaced.

What are possible complications of ERCP?

ERCP is a well-tolerated procedure when performed by doctors who are specially trained in the technique. Risks vary, depending on why the test is performed, what is found during the procedure, what therapy is done and whether the patient has major health problems. Although serious complications requiring hospitalization can occur, they are relatively uncommon. Your doctor will discuss your likelihood of complications with you before you undergo the test. Complications can include pancreatitis (inflammation of the pancreas), bleeding, infections, perforation (a hole or tear in the gastrointestinal tract lining) and anesthesia or medication reactions, which may cause a change in heart rate, blood pressure or breathing.

Some complications might require a blood transfusion, hospitalization or, rarely, surgery. It is possible your doctor will give you medications or place a stent to minimize these risks. Sometimes the procedure cannot be completed and could require another form of treatment or repeating the procedure.

It is important to recognize early signs of possible complications. Contact your doctor immediately if you have a fever after the test or if you notice trouble swallowing or increasing throat, chest or abdominal pain or bleeding, including black stools. If you have any concerns about a possible complication, it is always best to contact your doctor right away.

What can I expect after ERCP?

You will be sent home after the procedure when most of the effects of the medications have worn off. You might experience bloating or pass gas because of the air introduced during the examination. You can resume your usual diet unless you are instructed otherwise. Someone must accompany you home from the procedure because of the medications used during the examination. You should not drive, operate machinery or make legal decisions the day of the procedure to make sure that the effects of the medication have worn off. Even if you feel alert after the procedure, the medications can affect your judgment and reflexes for the rest of the day.

Your doctor generally can inform you of the preliminary results of the procedure that day, but the results of some tests, including biopsies, may take several days.

About the American Society for Gastrointestinal Endoscopy (ASGE)

Since its founding in 1941, the ASGE has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal (GI) endoscopy. ASGE physicians have highly specialized training in endoscopic procedures of the digestive tract, including upper GI endoscopy, flexible sigmoidoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).

Visit ASGE.org for details on ASGE’s Understanding ERCP

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.