Key takeaways:
Endoscopic retrograde cholangiopancreatogram (ERCP) is a procedure similar to an upper endoscopy. It gets a closer look at the bile duct, liver, and pancreas.
An ERCP can be used to diagnose and treat many conditions that affect these organs. These include gallstones, tumors, inflammation, and blockages.
This procedure is done with sedation, so you will be asleep during the whole thing. Most people have a quick recovery without any complications.
Endoscopic retrograde cholangiopancreatogram is a mouthful, which is why most people just call it ERCP. It’s a procedure that’s used to diagnose and treat conditions affecting the bile duct. The bile duct carries digestive fluids to the intestines.
The procedure can also be used to look at nearby organs involved in digestion — like the liver, gallbladder, and pancreas. To do this, a provider inserts a special device down the throat and into the stomach to get access to the bile duct. We’ll go through how that device can then be used to diagnose and treat certain conditions, and what to expect if you need to have an ERCP.
People will usually need an ERCP to diagnose or treat one of the following conditions:
Gallstones: These are solid collections of bile that form in the gallbladder. If they travel out of the gallbladder, then they can get stuck in the bile duct. This can cause pain, bile blockage, and infections. An ERCP can locate and remove the gallstone. This is the most common reason people need an ERCP.
Biliary strictures: These are areas in the bile duct that are too narrow for fluid to flow through it. Just like a gallstone, they can block the bile duct. An ERCP can look for strictures and place a stent to open it back up.
Pancreatitis: This is when the pancreas gets inflamed. A few different things can cause pancreatitis, and an ERCP can help diagnose the cause, including bile duct blockages. It can also be used to take a small sample of the pancreas to look for other causes.
Cancer: An ERCP can be used to take a biopsy of masses that could be cancer. This includes cancers of the bile duct, gallbladder, and pancreas.
Before an ERCP, you will be given sedation. This is a form of anesthesia, so you don’t feel or remember anything from the procedure. Since you will be asleep for most of the procedure, here’s a picture of what exactly happens during an ERCP.
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The first part of the procedure is a lot like an upper endoscopy. Your provider will insert a camera into the mouth. This camera will travel into the stomach and into the first part of the intestines. They use the camera to find the entrance to the bile duct.
The camera is able to insert a small device into the bile duct. This device can inject dye into the duct so it can take X-rays of the area. This will give your provider a clear picture of what your bile duct looks like — almost like a river on a satellite picture. Your provider can then use this picture to check for conditions or blockages of the bile duct.
If they find a problem they can fix — like a gallstone or stricture — that will happen next. As mentioned above, the gallstone can be removed. Or the bile duct can be opened up with a stent.
At the end of the procedure, the ERCP is removed. This is when the sedation medication is stopped, and you will be taken to the recovery area to wake up.
Your provider or healthcare team will give you instructions for what to do the day before an ERCP. This will include instructions about:
Food and drink: Most often, people are asked not to eat or drink after midnight on the day of their procedure. Your provider may also have instructions on specific foods to avoid before your procedure.
Medications: You may need to hold certain medications before your procedure. This is especially true for blood thinners and aspirin. If you have diabetes, you may also need to hold these medications since you will not be eating.
Transportation: If you’re getting an ERCP as a day procedure, you’ll want to arrange transportation to the healthcare center and back home. It isn’t safe to drive home after receiving sedation medications.
When you arrive at the clinic for your procedure, you can expect the following steps:
If you are coming from home — and not already staying in the hospital — you’ll likely be asked to change into a hospital gown. You may have to wait in a holding area until your team is ready to start the procedure.
A provider will start an IV (intravenous) line. This is so they can give you the sedation medications.
The care team will take you to the procedure room. This is where you will receive the sedative medications before the procedure starts.
The medications kick in within seconds. After that, you won’t remember any of the procedure.
The next thing you’ll experience is waking up in the recovery room. Your team may monitor you for 30 to 60 minutes to make sure the medications wear off.
Once you’re fully awake, you can return to your hospital room or go home if you’re not staying in the hospital.
Like any procedure, there are risks with an ERCP. The most common complication is pancreatitis. This may seem confusing, given an ERCP can be used to treat pancreatitis. But the dye or procedure instruments can also irritate the pancreas, leading to inflammation.
There are some less common complications as well. These include injury to the intestines or the bile duct. Bleeding in the intestines can also happen. Let your provider know if you experience any of the following symptoms after your procedure:
Nausea and vomiting
Blood in vomit
Severe abdominal pain
Red or black stools
Fever
These could be signs of a complication from the procedure. So talk with your provider or get checked out in an emergency department if any of these happen.
An ERCP is a helpful procedure for diagnosing and treating conditions that affect the gallbladder, bile duct, and pancreas. It may seem involved and complicated, but it’s similar to a colonoscopy or upper endoscopy. If you’re nervous about your procedure, the good news is that you will be comfortable and asleep for the procedure. Most people don’t have any complications and recover quickly.
American Society for Gastrointestinal Endoscopy. (n.d.). Understanding ERCP.
MedlinePlus. (2021). ERCP.
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Endoscopic retrograde cholangiopancreatography (ERCP).
Society of American Gastrointestinal and Endoscopic Surgeons. (2020). ERCP (endoscopic retrograde cholangio-pancreatography) patient information from SAGES.