What is ERCP?
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized procedure that combines upper gastrointestinal (GI) endoscopy and X-rays to diagnose and treat problems in the bile ducts, pancreas, and gallbladder.
ERCP is both a diagnostic and therapeutic procedure. It allows your doctor to not only identify problems but also treat them during the same procedure, avoiding the need for more invasive surgery.
The procedure involves passing an endoscope through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine). From there, the bile and pancreatic ducts can be accessed and examined.
Anatomy of the Biliary System
Biliary System Anatomy Diagram
Diagnostic Tool
Visualizes bile and pancreatic ducts to identify blockages, stones, or strictures
Therapeutic Procedure
Allows treatment of identified issues during the same procedure
Minimally Invasive
Avoids the need for traditional open surgery in many cases
The ERCP Procedure: Step by Step
Preparation & Sedation
You'll receive intravenous sedation to keep you comfortable. Fasting is required for 6-8 hours before the procedure.
Endoscope Insertion
A flexible endoscope is passed through your mouth, esophagus, and stomach into the duodenum.
Accessing the Ducts
A small tube (catheter) is passed through the endoscope into the opening of the bile and pancreatic ducts.
Contrast Injection & X-rays
Contrast dye is injected, and X-ray images are taken to visualize the ducts and identify any abnormalities.
Conditions Diagnosed and Treated with ERCP
Gallstones
Stones lodged in the common bile duct causing obstruction and pain
Biliary Strictures
Narrowing of the bile ducts due to inflammation, scarring, or tumors
Pancreatic Disorders
Chronic pancreatitis, pancreatic duct stones, or pancreatic leaks
Tumors
Cancers of the bile ducts (cholangiocarcinoma), pancreas, or gallbladder
Sphincter of Oddi Dysfunction
Abnormal function of the muscle controlling bile and pancreatic juice flow
Bile Duct Injuries
Leaks or damage to bile ducts following gallbladder surgery
Therapeutic Interventions During ERCP
ERCP allows for various treatments to be performed during the procedure:
- Sphincterotomy: Cutting the muscle at the end of the bile duct to remove stones or improve drainage
- Stone Removal: Extraction of gallstones from bile ducts using special baskets or balloons
- Stent Placement: Insertion of plastic or metal tubes to keep narrowed bile ducts open
- Stricture Dilation: Widening of narrowed bile ducts using balloon catheters
- Biopsy: Taking tissue samples for cancer diagnosis
- Nasobiliary Drainage: Temporary drainage tube placement for infected bile ducts
Need an ERCP Procedure?
If you're experiencing symptoms like jaundice, abdominal pain, or have been diagnosed with bile duct or pancreatic issues, ERCP may be the solution. Our expert team led by Dr. Jitendra Mohan Jha specializes in advanced endoscopic procedures.
Preparation for ERCP
Proper preparation is essential for a successful ERCP procedure:
- Fasting: No food or drink for 6-8 hours before the procedure
- Medication Review: Inform your doctor about all medications, especially blood thinners
- Allergies: Report any allergies, especially to iodine or contrast dye
- Medical History: Share details of previous surgeries and medical conditions
- Arrangements: Arrange for someone to drive you home after the procedure
Your doctor will provide specific instructions based on your individual health needs. Follow these instructions carefully to ensure the procedure can be performed safely and effectively.
Recovery After ERCP
After the procedure, you'll be monitored in a recovery area until the sedation wears off. Most people can go home the same day, though some may need to stay overnight for observation.
You may experience:
- Sore throat from the endoscope (usually resolves in 1-2 days)
- Bloating or gas from air introduced during the procedure
- Mild discomfort at the injection site
You'll receive specific post-procedure instructions regarding diet, activity, and medication. Contact your doctor immediately if you experience severe abdominal pain, fever, chills, or persistent vomiting.
Risks and Complications
While ERCP is generally safe when performed by experienced specialists, potential risks include:
- Pancreatitis: Inflammation of the pancreas (most common complication, occurring in 3-5% of cases)
- Bleeding: Especially after sphincterotomy (1-2% of cases)
- Infection: Of the bile ducts (cholangitis) in about 1% of cases
- Perforation: Tear in the intestinal wall or bile duct (less than 1%)
- Reaction to Sedation: Breathing problems or allergic reactions to medications
These complications are uncommon, and the benefits of diagnosing and treating serious biliary and pancreatic conditions generally outweigh the risks. Our team takes all necessary precautions to minimize these risks.
Frequently Asked Questions
The procedure typically takes 30-90 minutes, depending on the complexity of the case and whether therapeutic interventions are needed. You should plan to spend several hours at the facility for preparation and recovery.
You'll receive sedation to keep you comfortable throughout the procedure. Most patients don't remember the procedure and experience minimal discomfort. After the procedure, you might have a sore throat or mild abdominal discomfort that typically resolves quickly.
While both use an endoscope, ERCP is a specialized procedure that focuses on the bile ducts and pancreatic ducts. It involves X-ray imaging and allows for therapeutic interventions that aren't possible with standard endoscopy.
Your doctor will discuss preliminary findings with you immediately after the procedure. If biopsies were taken or stones removed, those results may take a few days. A detailed report will be provided to you and your referring physician.
Depending on your condition, alternatives might include MRCP (Magnetic Resonance Cholangiopancreatography) for diagnosis or surgical procedures for treatment. However, ERCP remains the gold standard for both diagnosing and treating many biliary and pancreatic conditions.
Most people can resume normal activities within 24 hours. However, you should avoid driving, operating machinery, or making important decisions for at least 24 hours due to the effects of sedation. Your doctor will provide specific instructions based on your procedure and overall health.