What is an ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts.


What are the bile and pancreatic ducts?

Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum. Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.

Why do doctors use ERCP?

Because an ERCP has a higher rate of serious complications than other endoscopy procedures, it is mainly used for treatment when the bile duct is blocked. It is used less often to make a diagnosis or to check for a problem in the ducts.

Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of:

• gallstones that form in your gallbladder and become stuck in your common bile duct

• infection

• acute pancreatitis

• chronic pancreatitis

• trauma or surgical complications in your bile or pancreatic ducts

• pancreatic pseudocysts

• tumors or cancers of the bile duct and or pancreas

How do I know when my stent needs to be changed?

If you have any of the following symptoms your stent may be blocked and should be changed contact your doctors office asap.

• dark urine

• jaundice

• fever

How do I prepare for ERCP?

For specific instructions on how to prepare for a ERCP, refer to the link at the bottom of this page.

How do doctors perform ERCP?

Doctors who have specialized training in ERCP perform this procedure in a outpatient setting ( TBRHSC, 3rd floor Endoscopy Unit). An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. A health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat. The anesthetic numbs your throat and helps prevent gagging during the procedure. The staff will monitor your vital signs and keep you as comfortable as possible. 

You’ll be asked to lie on an examination table. The doctor will carefully feed the endoscope down your esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to view.

During an ERCP the doctor locates the opening where the bile and pancreatic ducts empty into the duodenum slides a thin, flexible tube called a catheter through the endoscope and into the ducts injects a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible on x-rays uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages.

The doctor may pass tiny tools through the endoscope to:

• open blocked or narrowed ducts

• break up or remove stones

• perform a biopsy or remove tumors in the ducts

• insert stents—(tiny tubes that a doctor leaves in narrowed ducts to hold them open. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery

The procedure itself most often takes between 1- 2 hours.

What should I expect after ERCP?

After having a ERCP, you can expect the following:

• You will most often stay at the hospital or outpatient centre for 1 to 2 hours after the procedure so the sedation or anesthetic can wear off

• You may have bloating or nausea for a short time after the procedure

• You may have a sore throat for 1 to 2 days afterwards

• You can go back to a normal diet once your swallowing has returned to normal

• You should rest at home for the remainder of the day

If the doctor performed a biopsy, a pathologist will examine the biopsy tissue. Biopsy results take a few weeks or longer to come back. Once the results are available and the doctor has reviewed them you will be contacted for a follow up appointment.


What are the risks of ERCP?

The risks of ERCP include complications such as the following:

• pancreatitis

• infection of the bile ducts or gallbladder

• excessive bleeding, called hemorrhage

• an abnormal reaction to the sedative, including respiratory or cardiac problems

• perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into it

• tissue damage from x-ray exposure

• death, although this complication is rare

Seek care right away

If you have any of the following symptoms after ERCP, seek medical attention right away:

• bloody or black, tar-colored stool

• chest pain

• fever

• pain in your abdomen that gets worse

• problems breathing, problems swallowing or throat pain that gets worse

• vomiting—particularly if your vomit is bloody or looks like coffee grounds

Click below for instructions for your ERCP.

ERCP preperation