Endoscopic retrograde cholangiopancreatography (ERCP)

What is it?

Endoscopic retrograde cholangiopancreatography (ERCP) is a specialised endoscopic procedure used to diagnose and treat conditions affecting the bile and pancreatic ducts. ERCP is now performed mainly for treatment rather than diagnostic purposes.

During the procedure, a special side-viewing endoscope called a duodenoscope is inserted through the mouth and guided into the duodenum. Contrast medium is injected through the major duodenal papilla into the bile or pancreatic ducts, X-ray images are taken and, if necessary, therapeutic procedures are performed immediately.

When is ERCP performed?

• to remove stones from the bile ducts;
• to treat narrowing of the bile or pancreatic ducts;
• to insert stents;
• to restore bile drainage;
• to take tissue samples for biopsy or cytological examination;
• to treat certain complications that develop after surgery or liver transplantation.

How should I prepare?

• The procedure is usually performed in hospital as an inpatient or day-case procedure.
• You will usually need to avoid eating and drinking for 6–8 hours before the procedure, unless your doctor tells you otherwise.
• Make sure you tell your doctor about:
  • blood-thinning medicines, such as warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel and others;
  • any allergies, particularly allergies to contrast media;
  • pregnancy or the possibility that you may be pregnant;
  • heart, lung or other significant medical conditions.
• If you take medicines that affect blood clotting, do not stop taking them without medical advice. Your doctor will explain which medicines need to be adjusted and for how long before the procedure.

How is the procedure performed?

• The procedure is usually performed under general anaesthesia or deep sedation.
• During the procedure, the doctor may:
  • make a small cut in the duodenal papilla (sphincterotomy);
  • remove stones from the bile ducts;
  • dilate narrowed ducts;
  • insert plastic or metal stents;
  • take tissue samples.

The procedure usually takes 30–90 minutes, depending on the interventions performed.

After the procedure

• After ERCP, you will be monitored in hospital for several hours or, commonly, until the following day.
• You may eat and drink only when permitted by the medical staff.
• You must not drive on the same day.
• Mild abdominal bloating or a sore throat after the procedure is common and usually passes quickly.

Is ERCP safe?

ERCP is an effective and widely used procedure. However, like any invasive intervention, it can cause complications.

The most common complications include:

• acute inflammation of the pancreas (pancreatitis);
• bleeding;
• infection of the bile ducts (cholangitis);
• very rarely, a hole in the duodenum or bile ducts (perforation).

The overall complication rate is approximately 4–7%, but most complications are treated successfully. Before the procedure, your doctor will assess your individual risks and explain the potential benefits and alternatives.