ERCP stands for endoscopic retrograde cholangiopancreatography. A thin, flexible tube with a tiny TV camera on the end (endoscope) is passed through the mouth into the esophagus, stomach, and duodenum until the common opening to the bile duct and pancreatic duct is visually identified. A catheter is passed through the endoscope into the ducts. Dye is then injected into the bile duct and/or the pancreatic duct and x-rays are taken.
Reasons for the exam
- Jaundice: Yellow discoloration of the skin or eyes can be a sign of blockage of the flow of bile through the bile duct caused by gallstones, tumors, or strictures. ERCP can identify the cause.
- Abnormal liver function: Diseases of the bile ducts, which can result in liver dysfunction, can often be identified by ERCP.
- Undiagnosed abdominal pain: Gallstones, pancreatitis, cysts in the bile ducts, spasm of the common opening to the ducts, and other causes of abdominal pain can be identified. The lining of the stomach and duodenum is observed during the ERCP and so ulcers and gastritis can be identified. Areas that look abnormal can be biopsied. Please refer to Upper GI Endoscopy.
- Pancreatitis: Pancreatitis can be caused by gallstones in the bile duct and by intrinsic abnormalities in the pancreatic duct. Identification of such abnormalities may lead to appropriate treatment.
Abnormal CT scan or ultrasound
Abnormalities seen on indirect testing such as ultrasound and CT scan often need to be confirmed or clarified with ERCP.
If a gallstone is found in the bile duct, it can be removed at the time of ERCP. If there is a narrowing in the bile duct due to stricture (scar tissue) or tumor, a small tube (stent) can be placed to open it back up.
Preparation for the exam
The only preparation needed for an ERCP is to not eat or drink for eight hours prior to the exam. If you are taking diabetes medications, aspirin, or blood thinners (Coumadin), check with your physician.
Description of the procedure
The procedure is performed in the x-ray department. The back of the throat may be anesthetized by a spray. Intravenous sedation is used to relax the patient and ensure comfort during the procedure. The patient will generally be lying on his/her abdomen with face toward the right. The endoscope is then gently inserted through the mouth into the upper esophagus. It does not interfere with breathing. The examination may take 20 to 40 minutes, after which the patient is taken into a recovery area until the sedation starts to wear off. There is no pain with the procedure. Air is placed into the stomach and therefore patients often feel somewhat bloated and may belch during the procedure. Patients who are given sedation should not drive a car for at least 12 hours and will need to arrange for a ride home.
Risks of the exam
The most common complication is pancreatitis (inflammation of the pancreas). This occurs in 3-5% of cases. It causes abdominal pain and may require hospitalization. In rare instances there may be bleeding or injury to the bile duct or intestine.
Ultrasound and CT scans can provide alternative ways to visualize the pancreas, and liver, and gallbladder, and can provide indirect evidence of blockage of the bile duct and pancreatic duct. An alternative method to inject dye into the bile duct is by placing a needle through the skin into the liver. Small tubing can then be threaded into the bile duct (percutaneous cholangiogram). Magnetic resonance cholangiogram is a new technique that can identify stones in the bile duct. Unlike ERCP, it does not allow removal of stones when found.