What is ERCP?

ERCP stands for endoscopic retrograde cholangiopancreatography. ERCP is a gastroenterology procedure used to study the ducts (drainage tubes) from the liver, gallbladder, and pancreas. Physicians with special training can accomplish ERCP in about 95% of cases.

Why Do I Need an ERCP?

ERCP can be helpful in diagnosing or treating a number of conditions such as:

  • Gallstones which are trapped in the main bile duct.
  • Blockage of the bile duct.
  • Yellow jaundice (the skin becomes yellow).
  • Pancreatitis (inflammation of the pancreas).
  • Cancer of the bile ducts of pancreas.
  • Abdominal pain of several causes.

What Are the Benefits Of an ERCP?

ERCP is the least invasive and most specific way of evaluating the bile ducts and pancreatic ducts. It can be performed safely and with minimal discomfort to you. In addition to providing a diagnosis, in many cases it allows the physician to perform specific treatment.

Is There an Alternative To an ERCP?

Yes. One alternative to ERCP would be exploratory surgery.

Another alternative is percutaneous transhepatic cholangiography involves passing a needle through the skin and the liver into the bile ducts under X-ray guidance. 

This procedure is more painful, has a slightly greater risk of complications, and does not offer visualization of the pancreas.

Are There Side Effects and/or Risks To an ERCP?

No test is 100% accurate, and infrequently ERCP can miss abnormalities which are present. In addition, sometimes for anatomical reasons, it is not possible to inject the contrast material into the ducts. 

  • A mild sore throat occasionally follows the procedure. 
  • You may have a feeling of bloating which is also temporary. 

While extremely uncommon, some complications may occur: 

  • Oversedation occurs infrequently and almost always can be reversed. 
  • A localized irritation of the vein can occur at the IV site, resulting in a tender lump which may last for several weeks. Application of hot moist towels may relieve the discomfort.
  • Pancreatitis (inflammation of the pancreas) occurs in about 2-5% of cases (5-10% if sphincterotomy is required). In most cases, the pancreatitis is mild, but severe cases can occur. 
  • Bleeding (rarely requiring transfusion or surgery)
  • Perforation (a tear in one of the organs)
  • Infection of the bile or pancreas
  • Worsening of underlying heart or lung disease
  • An adverse reaction to one of the sedatives 

Any of these complications could involve hospitalization, emergency surgery, or, in an exceptionally rare case, death.

What Will Happen When I Arrive for My ERCP?

  • A brief medical history will be reviewed with you by a nurse.
  • You will provide a list of any current medications you are taking along with any allergies you have to medications.
  • You will be asked to remove your clothing and change into a patient gown.

What Will Happen During My ERCP?

  • An intravenous (IV) catheter will be placed into your arm so that medications can be given for sedation. It is generally not a painful exam, but the sedation helps you to relax.
  • Most of the effects of the sedation persist for 15-60 minutes, and you may not be able to recall the procedure afterwards. 
  • Your throat is usually anesthetized with a spray or liquid to minimize the gag reflex. 
  • The endoscope is then gently inserted into the upper esophagus and advanced through the upper airway. It does not interfere with normal breathing. 
  • You will be monitored closely throughout the exam. 
  • As the exam takes place, any additional necessary procedures are performed. For example, a biopsy can be performed where a small piece of tissue is removed for microscopic analysis.

What Will Happen After My ERCP?

  • You will remain in the recovery room area for one hour or more after the procedure, depending on your vital signs and level of consciousness. 
  • You may feel bloated from the air used during the procedure. 
  • The medication given to you during the procedure may affect your reflexes and judgment. 
  • Following the exam, your physician will discuss the results with you and your loved ones. It takes an average of three hours after the exam to receive your results.
  • You should not drive a car, operate machinery, or make any legally-binding decisions for the remainder of the day.

What else should I know about my ERCP?

  • If you are on blood thinner medication, such as Coumadin® or warfarin, it is important to let us know well in advance of your appointment. If you are currently taking these medications and have not already given that information to our office, please call immediately. A nurse will contact you with instructions about taking your Coumadin® prior to this procedure.
  • YOU MUST HAVE SOMEONE TO DRIVE YOU HOME, OR THE DOCTOR WILL NOT DO THE PROCEDURE. If your driver does not plan to stay during your procedure, you will need to provide a phone number where that person can be contacted.
  • Using a small amount of water, take your prescription medications as you usually do unless you have been instructed to hold off the medication prior to the procedure. 
  • It is very important that you take your blood pressure or heart medication as usual.
  • Bring your insurance cards with you.
  • If you are a diabetic, check your blood sugar at home before your procedure.
  • If you have an implanted cardiac defibrillator, it is very important that you bring the card identifying the device manufacturer, model and serial number.
  • You may wear your glasses, dentures, or hearing aids. It is best to leave your jewelry at home.

How do I prepare for my ERCP?

Please click the button below to view the preparations for your ERCP: