Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure that is used to diagnose and treat diseases of the bile and pancreatic ducts.

What are bile and pancreatic ducts?

Bile and pancreatic juices support digestion. Bile ducts carry bile from the liver to the gall bladder and small intestine. The ducts merge into a common bile duct that empties into the small intestine.

Pancreatic ducts transport pancreatic juice from the pancreas to the small intestine. Small pancreatic ducts empty into the main pancreatic duct that leads into the small intestine.

How it works

ERCP uses a combination of X-rays, endoscopy and injectable dyes to visualise organs and vessels clearly. During the procedure, your doctor will use a catheter, a thin flexible tube equipped with a light and camera. Your doctor can use the catheter to:

• Guide the camera to the area of the small intestine where the bile and pancreatic ducts connect.
• Thread small tools through the catheter to perform various procedures.
• Squirt dye into the bile system and pancreas to highlight all the vessels.
• Take X-rays to form a clear and detailed picture.

Why do you need ERCP?

ERCP may be recommended to diagnose, assess and treat symptoms or conditions such as:

• Infection in the bile ducts
• Unexplained upper abdominal pain
• Unexplained yellowing of the skin or eyes (jaundice)
• Lesions, tumours or cancer in the pancreas, gall bladder or liver
• Acute and chronic pancreatitis (inflammation of the pancreas)
• Gallstones or blockages of the bile ducts

ERCP is also used before and after gall bladder surgery to better plan the surgical procedure and monitor outcomes.

What are the risks and complications of ERCP?

ERCP is a safe procedure. However some uncommon, but potential complications include:

• Excessive bleeding
• An abnormal reaction to the sedative
• Infection of the bile ducts or gall bladder
• Pancreatitis (inflammation of the pancreas)
• Tearing of the bile or pancreatic ducts, or near the small intestine opening
• Tissue damage from X-ray exposure

Potential risks vary, based on your health and pre-existing conditions. Our doctors will review your medical history to carefully assess your suitability for the procedure.

How do you prepare for ERCP?

Your doctor will review your medical history and risk factors.

Please inform your doctor about:

• Any allergies or medical conditions
• All prescribed and over-the-counter medicines, vitamins, and supplements
• Any pregnancy or plans to conceive so that safety measures can be taken

You may be asked to pause medicines that affect blood clotting or interact with sedatives.

Note: Before the procedure, you should not eat or drink for 8 hours. This helps to ensure a clear view of your upper gastrointestinal tract.

What can you expect in ERCP?

ERCP is often performed as an outpatient procedure. This means that you should be able to go home within the same day.

In some instances, you may be required to stay overnight in the hospital for additional monitoring.

You will be sedated during the entire procedure so that you are comfortable.

Estimated duration

The ERCP typically takes between 1 – 2 hours.

Before the procedure

You will be given a sedative via an intravenous needle in your arm. This will help you to feel relaxed and comfortable.

Additionally, you will be given an anaesthetic gargle to numb the throat and prevent gagging during the procedure.

During the procedure

You will be asked to lie on your left side or on your stomach.

An endoscope will be inserted through your mouth and carefully guided through the oesophagus (gullet or food pipe) and stomach. The goal is to reach the first section of the small intestine where the opening of the bile and pancreatic ducts are located.

Your doctor will flush dye into the ducts to highlight them while taking X-ray images. This step provides clear and detailed pictures of the structures. Your doctor may also take tissue samples or remove any small stones.

After the procedure

After the procedure is completed, you will be monitored for 1 – 2 hours to wait for the effects of the sedatives and anaesthesia to wear off.

In most cases, you will be able to return home to rest.

Note: Driving is strongly discouraged within 24 hours of an ERCP procedure as the sedatives and anaesthesia will take some time to fully wear off. Please make plans to have someone take you home after the procedure.

Care and recovery after ERCP

After the procedure, you may experience:

• Bloating or nausea for a short time
• Sore throat for 1 – 2 days