Endoscopic Retrograde Cholangiopancreatography (ERCP)

Endoscopic Retrograde Cholangiopancreatography (or ERCP) is a minimally-invasive procedure that allows a highly-trained gastroenterologist to diagnose and treat various conditions of the digestive system. The bile ducts, pancreas, liver, and sometimes gallbladder all may be evaluated using ERCP.

Endoscopic refers to the use of an endoscope, a thin flexible tube equipped with a tiny video camera. Retrograde means backward and is a reference to the direction that a special dye is injected through either the bile or pancreatic ducts during ERCP. Once the dye is injected, pictures (X-rays) are taken that allow the doctor to see where problems such as widening, narrowing or blockage of the ducts are taking place. The process of taking these X-rays is known as cholangiopancreatography ("cholangio" refers to the bile duct system, "pancrea" to the pancreas).

What conditions are diagnosed or treated using ERCP?

Various conditions of the liver, gallbladder, bile ducts and pancreas are evaluated using ERCP, often after a blood test, ultrasound, endoscopic ultrasound (EUS), CT scan, or MRI shows something abnormal. Blockages of the bile ducts by gallstones, tumors, scarring, or other conditions can be evaluated using ERCP. Similar blockages of the pancreatic ducts are also assessed using ERCP.

If stones are found in the bile or pancreatic ducts during ERCP, it is usually possible to remove them through the endoscope. Narrowing or blockage caused by tumors or scarring can sometimes be treated during ERCP by creating an opening and inserting a plastic or metal tube called a stent.

Who is a candidate for ERCP?

Patients whose symptoms suggest diseases or conditions of the liver, gallbladder, bile ducts, pancreas and pancreatic ducts are candidates for ERCP. These include people with pancreatitis (inflammation of the pancreas), a swollen bile duct on imaging, jaundice (yellowing of the whites of the eyes), abnormal liver function tests, or cholangitis (infection in the liver or bile ducts). ERCP also provides the doctor a closer look at patients with abnormal blood tests, CT scans or ultrasound results.

ERCP may also be used before or after gallbladder surgery to treat bile duct stones. Bile duct complications from surgery and continued pain after gallbladder surgery may also be evaluated using ERCP.

ERCP is also used in patients with pancreatic disease as a minimally-invasive approach to treatment or to determine the need for – or best approach to –surgery.

How do I prepare for ERCP?

Patients having ERCP may not eat or drink anything after midnight the night before the procedure. Essential medications may be taken with a small amount of water first thing in the morning.

Your doctor will want to know about any medication you are taking including aspirin, aspirin-containing drugs, blood thinners, antacids, insulin and other diabetes drugs. He or she will also ask about your general health and any allergies you may have to shellfish, iodine, antibiotics, pain medication or other drugs.

What can I expect during recovery from ERCP?

If your ERCP is being done on an outpatient basis, you will be under observation for an hour or two until your doctor or health care team determines you can return home. You will need to have someone drive you home since you will still be drowsy from the sedation used during the procedure. You should return home and rest. Also, refrain from operating machinery or drinking alcohol for a day.

Usually after a few hours, you may begin taking fluids and meals, and your doctor will give you instructions about this and about resuming routine medications. You may feel full and pass gas for awhile after ERCP because of the air introduced into your system during the procedure. Brief changes in bowel habits are not unusual, but bleeding from your rectum or black, tarry stools should be reported to your doctor.

Vomiting, severe abdominal pain, skin or eye yellowing, weakness, dizziness, chills or fever above 100 degrees also needs to be reported to your doctor.

If complications arise during your ERCP, you may be admitted to the hospital overnight for observation.

What are the risks or complications associated with ERCP?

ERCP has a 5 to 20 percent risk of complications depending on the individual patient, disease and type of procedure or treatment performed. On rare occasions, severe complications may require a prolonged hospital stay and can very rarely result in death.

The most common complication is mild to severe inflammation of the pancreas (pancreatitis), occurring in up to 10 percent of ERCP patients. In most cases, the condition settles in one to four days but it generally requires admission to the hospital.

In fewer than 1 percent of patients, severe damage to the pancreas can result in an abscess requiring a prolonged hospital stay to treat, and sometimes surgery.

Bleeding can occur during or after ERCP if a small internal incision is made to remove stones or to insert a stent. This usually stops on its own, but may require further treatment or, rarely, a blood transfusion.

Punctures or perforation of the bowel wall or bile duct can occur with ERCP and may require surgical treatment. Infection can also occur, especially if the bile duct is blocked.

Infection in the bile duct or pancreas may be triggered by ERCP, especially if a duct obstruction could not be fully treated during the procedure. Antibiotics and possibly a drainage procedure such as surgery or a drain placed through the skin may be used to treat the infection. Severe complications that require prolonged hospital stays, treatment in an intensive care unit or surgery are seen in fewer than 1 percent of ERCP procedures.
