What is ERCP?

ERCP is a procedure that enables your doctor to examine the pancreatic and bile ducts. These important tubes drain the gall bladder, liver and pancreas.  They play a vital role but are sometimes prone to blockage.  A flexible, lighted tube (endoscope) about the thickness of your index finger is placed through your mouth and into your stomach and top part of the small intestine (duodenum). In the duodenum a small opening is identified (ampulla) and a small plastic tube (cannula) is passed through the endoscope and into this opening. Dye is injected and X-rays are taken to study the ducts of the pancreas and liver.  Findings may include stones and narrowing of the tubes which may be benign or cancerous. 

Why is an ERCP performed?

ERCP is most commonly performed to diagnose disease conditions of the pancreas or bile ducts, and is also used to treat those conditions. It may be used to evaluate symptoms suggestive of disease in these organs, or to clarify abnormal results from blood tests or imaging. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or an abnormal growth in these organs.

ERCP may also be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP without the need for further invasive surgery. Tumours, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic or metal tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can also be removed by ERCP.

What can be expected during the ERCP?

Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the intestine. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor temporary discomfort.

What complications can occur?

ERCP is safe when performed by gastroenterologists and surgeons who have had specific training and are experienced in this specialized endoscopic procedure. Complications are rare, however, they can occur. Pancreatitis due to irritation of the pancreatic duct by the X-ray contrast material or cannula is the most common complication. Sometimes, a reaction to the sedatives can occur. Irritation to the vein in which medications were given is uncommon, but may cause a tender lump lasting a few weeks. Warm moist towels will help relieve this discomfort.

If your ERCP includes a therapeutic procedure such as removal of stones or placement of a stent (drain), there are additional small risks of bleeding or perforation (making a hole in the intestine). Blood transfusions are rarely required. It is important for you to recognize the early signs of possible complications and to contact us if you notice symptoms of severe abdominal pain, fever, chills, vomiting, or rectal bleeding.