Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and an endoscope—a long, flexible, lighted tube. Your healthcare provider guides the scope through your mouth and throat, then down the esophagus, stomach, and the first part of the small intestine (duodenum). Your provider can view the inside of these organs and check for problems. Next, they will pass a tube through the scope and inject a dye into the ducts draining your liver (biliary ducts) and the duct draining your pancreas (pancreatic duct). This part of the ERCP highlights the structures in these organs on X-ray.

Why might I need ERCP?

You may need ERCP to find the cause of unexplained belly (abdominal) pain or yellowing of the skin and eyes (jaundice). It may be used to get more information if you have pancreatitis or cancer of the liver, pancreas, or bile ducts.

Other things that may be found with ERCP include:

• Blockages or stones in the bile ducts

• Fluid leakage from the bile or pancreatic ducts

• Blockages or narrowing of the pancreatic ducts

• Tumors

• Infection in the bile ducts

Your healthcare provider may have other reasons to advise an ERCP.

What are the risks of ERCP?

You may want to ask your healthcare provider about the amount of radiation used during the test. Also ask about the risks as they apply to you.

Consider writing down all X-rays you get, including past scans and X-rays for other health reasons. Show this list to your provider. The risks of radiation exposure may be tied to the number of X-rays you have over time.

If you are pregnant or think you could be, tell your provider. Radiation exposure during pregnancy may lead to birth defects.

Tell your provider if you are allergic to or sensitive to medicines, contrast dyes, iodine, or latex.

Some possible complications may include:

• Inflammation of the pancreas (pancreatitis) or gallbladder (cholecystitis). Pancreatitis is one of the most common complications. Talk about this with your provider before the test. Keep in mind that ERCP is often done to help ease symptoms in certain types of pancreatitis.

• Infection

• Bleeding

• A tear in the lining of the upper part of the small intestine, esophagus, or stomach

• Collection of bile outside the biliary system (biloma)

You may not be able to have ERCP if:

• You’ve had digestive surgery that has blocked the ducts of the biliary tree.

• You have pouches in your esophagus (esophageal diverticula) or duodenum or other abnormal anatomy that makes the test hard to do. Sometimes the ERCP is changed to make it work in these cases.

• You have barium in the intestines from a recent barium procedure. This may interfere with an ERCP.

You may have other risks, based on your condition. Talk about any concerns with your provider before the test.

How do I get ready for ERCP?

The following can help you get ready for ERCP:

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

• Tell your provider if you have ever had a reaction to any contrast dye, or if you are allergic to iodine.

• Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthesia.

• Follow any directions you are given for not eating or drinking before the procedure.

• Tell your provider if you are pregnant or think you could be.

• Tell your provider about all the prescription and over-the-counter medicines and herbal supplements you are taking.

• Tell your provider if you have a history of bleeding disorders. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, ibuprofen, naproxen, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.

• If you have heart valve disease, your provider may give you antibiotics before the procedure.

• You may be awake during the procedure. But you will get a sedative before it starts. Depending on the anesthesia used, you may be completely asleep and not feel anything. You will need someone to drive you home.

• Follow any other instructions your provider gives you to get ready.

What happens during ERCP?

You may have an ERCP as an outpatient or as part of your stay in a hospital. Procedures may vary based on your condition and your healthcare provider's practices.

Generally, an ERCP follows this process:

1. You will need to remove any clothing, jewelry, or other objects that may interfere with the procedure.

2. You will need to remove clothes and put on a hospital gown.

3. An IV (intravenous) line will be put in your arm or hand.

4. You may get oxygen through a tube in your nose during the procedure.

5. You will be positioned on your left side or, more often, on your belly, on the X-ray table.

6. Numbing medicine may be sprayed into the back of your throat. This helps prevent gagging as the endoscope is passed down your throat. You will not be able to swallow the saliva that collects in your mouth during the procedure. It will be suctioned from your mouth as needed.

7. A mouth guard will be put in your mouth to keep you from biting down on the endoscope and to protect your teeth.

8. Once your throat is numbed and you are relaxed from the sedative, your provider will guide the endoscope down the esophagus into the stomach and through the duodenum until it reaches the ducts of the biliary tree.

9. A small tube will be passed through the endoscope to the biliary tree. Contrast dye will be injected into the ducts. Air may be injected before the contrast dye. This may cause you to feel fullness in your abdomen.

10. The provider will take various X-ray views. You may be asked to change positions during this time.

11. After X-rays of the biliary tree are taken, the provider will reposition the small tube for dye injection into the pancreatic duct. Contrast dye will be injected into the pancreatic duct. The provider will take X-rays. Again, you may be asked to change positions while the X-rays are taken.

12. If needed, your provider will take samples of fluid or tissue. They may do other procedures, such as the removal of gallstones or treatment of blockages, while the endoscope is in place.

13. After the X-rays and any other procedures are done, the endoscope will be removed.

What happens after ERCP?

After the procedure, you will be taken to the recovery room. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged home. If this procedure was done as an outpatient, plan to have someone drive you home.

You won't be allowed to eat or drink anything until your gag reflex has returned. You may have a sore throat and pain with swallowing for a few days. This is normal.

Many times, a rectal suppository is given after the ERCP. This decreases the risk for pancreatitis.

You may go back to your normal diet and activities after the procedure, unless your healthcare provider tells you otherwise.

Tell your healthcare provider if you have any of the following:

• Fever or chills

• Redness, swelling, or bleeding or other drainage from the IV site

• Abdominal pain, nausea, or vomiting

• Black, tarry, or bloody stools

• Trouble swallowing

• Throat or chest pain that worsens

Your provider may give you other instructions after the procedure, based on your situation.

Next steps

Before you agree to the test or the procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure