ERCP (Endoscopic Retrograde Cholangiopancreatography)

Written by Erica Roth | Published on June 1, 2012
Medically Reviewed by George Krucik, MD

What Is ERCP?

ERCP is a test used to look for and treat abnormalities in the pancreas, bile ducts, and gallbladder. ERCP is an abbreviation for “endoscopic retrograde cholangiopancreatography.” ERCP is a combination of two different types of tests: an endoscopy and an X-ray.

An endoscopy is a procedure in which a thin, flexible tube attached to a tiny camera is threaded down to your gastrointestinal (GI) tract. Your GI tract consists of your esophagus, stomach, and intestines.

“Retrograde” refers to the fact that the doctor will inject a contrast dye into your ducts in a backward flow pattern. Contrast dye is an iodine-based fluid that highlights the ducts to make them more visible on an X-ray.

An X-ray is a picture of a specific area of your body. In this case, the X-rays show the insides of your bile and pancreatic ducts. The bile ducts are also sometimes called biliary ducts.

Why Is ERCP Used?

Your pancreatic and bile ducts play an important role in the digestion process. The pancreas releases enzymes that aid digestion and mix with bile. Bile is a substance produced by and stored in the liver. Bile helps you digest fat, and is delivered to your gallbladder through bile ducts. Problems with either of these organs, such as a narrowing of the ducts, can hamper the absorption of nutrients. You can also develop jaundice, a yellowing of the skin and the whites of your eyes, if your liver function is compromised.

ERCP can diagnose blockages in the ducts, and can sometimes treat the problem during the procedure.

Preparing for ERCP

The doctor performing your ERCP must be able to see your GI organs clearly. This is easier when your stomach is empty, so you will be asked to fast beforehand. Do not eat or drink after midnight if you are scheduled for a morning ERCP. Fast for at least six hours if your procedure is scheduled for later in the day.

Let your doctor know about all medications, vitamins, and supplements you take. You might be asked to temporarily stop taking medications that contain aspirin or other blood thinners. Examples of these medicines can include:

  • aspirin
  • heparin
  • ibuprofen
  • naproxen sodium
  • warfarin

Tell your doctor about any food and drug allergies you have. People who are allergic to seafood and iodine are more likely to experience an adverse reaction to contrast dye. Of course, if you have had bad reactions to contrast dye in the past, alert your doctor.

The ERCP Procedure

For most patients, ERCP is performed as an outpatient procedure. You are sedated, but remain awake during the procedure. After the procedure is completed and the sedative has worn off, you can go home.

You will receive sedative medication intravenously in your arm to help you relax during the ERCP procedure. Your doctor might also spray a general anesthetic in your throat. This helps the endoscope enter your throat and digestive system with little discomfort. You will probably feel sleepy during the procedure.

The doctor who performs the ERCP is a gastroenterologist, a specialist who studies the gastrointestinal tract. They will thread the endoscope down your esophagus to your stomach and the upper part of your small intestine. The gastroenterologist might pump some air into your stomach through the endoscope. The air helps the doctor gently push the scope through to the upper area of your intestines, called the duodenum.

There is a small opening in the intestines called the papilla where the bile ducts connect with the duodenum. The doctor will put a fine tube called a cannula into the papilla. The cannula carries the contrast dye to the pancreatic or biliary ducts. The dye is injected in a retrograde, or backward flow, toward the pancreas. The contrast dye helps your doctor see abnormalities in the ducts. Abnormalities can include narrowed areas, scar tissue, and blockages. Narrowed spots in the ducts are called strictures. Blocked ducts may be due to gallstones, a solid mass of hardened bile, or tumors.

Strictures and gallstones can be treated with ERCP in many cases. Placing a tiny tube in the duct can treat strictures. The tube, called a stent, is placed into the duct through the endoscope. Gallstones can be removed or dissolved through the endoscope as well.

ERCP identifies the reasons why the ducts are blocked, such as inflammation of the pancreas or biliary tumors. Medications or surgery may be required to treat these conditions.

Recovery From ERCP

After the ERCP, you will be monitored for a brief recovery time. As your blood pressure and oxygen levels remain normal, and you become more alert, you can go home. Bring someone to drive you home, as you may still be drowsy after your procedure. Gas is the most common complaint after ERCP. Soft stools may also be a temporary side effect of the procedure. You can return to a normal diet and work schedule as soon as you feel ready.

Notify your doctor if you experience severe abdominal pain, vomiting, fever, or blood in the stool.

Potential Risks and Complications

ERCP is generally a very safe procedure. The American Gastroenterological Association estimates that only five to 10 percent of patients suffer from complications related to ERCP (AGA, 2012). The most common risk is inflammation of the pancreas. Excessive bleeding may occur in a small number of patients. This is especially true in those who have stones removed from the bile ducts during the procedure. Puncture of the bile duct or bowel wall and infection are rare risks of ERCP. These complications may require hospitalization.

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