Endoscopic 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.

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What are the risks of ERCP?

The risks of ERCP include complications such as the following:

  • pancreatitis
  • infection of the bile ducts or gallbladder
  • excessive bleeding, called hemorrhage
  • an abnormal reaction to the sedative, including respiratory or cardiac problems
  • 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
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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.

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