Endoscopic retrograde cholangio-pancreatogram (or ERCP)

What is an ERCP?

An ERCP (endoscopic retrograde cholangio-pancreatography) is a procedure that combines an endoscopy with X-rays to look at, and often treat, your bile ducts and pancreatic duct. These are the tubes that carry bile from your liver and gallbladder, and digestive juices from your pancreas, into your small bowel (duodenum).

Why might I need an ERCP?

You might need an ERCP if your bile or pancreatic ducts are leaking, narrowed or blocked, for example because of gallstones, infection, pancreatitis, or a tumour in the bile ducts or pancreas. It's also used to relieve jaundice (yellowing of your skin or eyes) if this is caused by a blockage.

Doctors usually use ERCP when they expect to treat a problem during the same procedure. If only a diagnosis is needed, tests that don't enter your body, such as an MRI scan of the bile ducts or an endoscopic ultrasound, are used instead, as they carry less risk.

What are the benefits of having one?

Because ERCP combines looking at your ducts with the ability to treat problems straight away, such as removing a blockage, many people can be diagnosed and treated in a single procedure rather than needing separate appointments.

What can be done during an ERCP?

ERCP isn't just one fixed procedure. Depending on what's found, your doctor may also:

• insert a stent (a small plastic or metal tube) to keep a duct open
• perform a sphincterotomy, a small cut to widen the opening of the duct, to help bile drain or to remove stones
• take a biopsy (a small tissue sample) for testing
• inject a dye so the ducts show up more clearly on X-ray.

How do I prepare for an ERCP?

You'll need to talk to your doctor about your medical history, any allergies, and all the medicines, vitamins and supplements you take, including aspirin, arthritis medicines, blood pressure medicines, blood thinners, and anti-inflammatory painkillers such as ibuprofen or naproxen.

You can take most medicines as usual, but you may need to adjust or stop some beforehand, so check with your doctor. Tell your doctor if you're pregnant or think you might be.

You'll usually need to avoid eating or drinking for 6 to 8 hours before the procedure, and you'll need to arrange for someone to give you a ride home afterwards, as the sedative needs time to wear off before you can drive. You may also be given antibiotics beforehand to help prevent infection.

What happens during the procedure?

An ERCP usually follows these steps:

1. A healthcare professional places a small tube (a cannula) into a vein in your arm or hand, to give you a sedative and pain relief, which may make you feel forgetful about parts of the test afterwards
2. You may be given a liquid or spray medicine to numb your throat and help stop you gagging
3. You'll lie on an exam table while your doctor carefully passes the endoscope down your throat, into your stomach and duodenum, with air pumped in to make things easier to see
4. Your doctor passes a thin tube (a catheter) through the endoscope and into your bile or pancreatic ducts, then injects a dye so the ducts show up clearly on X-ray
5. Your doctor examines the ducts using X-ray imaging, and may carry out treatment, such as removing a blockage, inserting a stent, or taking a biopsy, during the same procedure.

The procedure itself usually takes between 15 and 40 minutes, depending on what needs to be done.

What happens after the procedure?

You may feel bloated, a little sick, or have a sore throat for a short time afterwards, along with some mild stomach cramps, which should soon settle.

You'll usually need to stay at the hospital for 2 to 6 hours afterwards so the sedative can wear off, and some people need to stay overnight.

You'll be given instructions on caring for yourself at home, and you may be told to have only clear liquids for 4 to 6 hours afterwards, with some people needing to wait 24 hours before eating solid food.

Some results are available straight away, though if a biopsy was taken, this can take a few days or longer to come back.

What are the risks?

ERCP is generally safe, but as with any procedure, there are some risks. These occur in around 5% to 10% of procedures overall, and include:

• pancreatitis (inflammation of the pancreas), with a risk of around 2% to 5%
• bleeding, infection of the bile ducts, or a tear (perforation) in the ducts or duodenum, each occurring in around 1 in 100 procedures, though these become more common if a sphincterotomy is performed
• a reaction to the sedative, such as breathing, heart rate or blood pressure problems, which usually settle quickly, occurring in around 1 in 200 procedures
• a small risk to your teeth or dental work
• rarely, a need for surgery or a blood transfusion afterwards.

There's also a small risk of death associated with ERCP, estimated at around 1 in 500 procedures. Your doctor will discuss these risks with you and explain why the benefits of the procedure are thought to outweigh them in your particular situation.

Contact your doctor or seek medical care straight away if you notice black or bloody stools, a fever, severe pain in your chest or tummy, difficulty breathing, worsening throat pain or difficulty swallowing, or if you're vomiting blood or dark material that looks like coffee grounds.