ERCP (which stands for endoscopic retrograde cholangiopancreatography) is a procedure performed to diagnose diseases of the gallbladder, liver, pancreas, and biliary system. The test looks to the liver, gallbladder, and pancreas, which are the areas where digestive fluid comes from, and then to where it enters the intestines. ERCP can also be used for treatment of problems in these areas of the digestive system.

What Happens During ERCP?

During ERCP, a gastroenterologist uses a special endoscope.  An endoscope is a long, flexible tube with a light and camera at the tip.  It is used to examine the inside of the digestive system. The doctor can identify the point where the bile duct enters into the intestine.  The doctor then feeds a small catheter into the duct and inserts a contrast agent while X-rays are done. The contrast agent aids in helping the doctor to see the bile ducts, the pancreatic duct, and the gallbladder on the X-rays.

When the source of the problem is found, the doctor can treat it with one of the following procedures.

  • Sphincterotomy. This involves making a tiny incision in the opening of the bile duct or the pancreatic duct.  This can help to appropriately drain small gallstones, bile, and pancreatic juice.
  • Stent placement. A stent serves as a drainage tube.  It is placed in the bile duct or the pancreatic duct and holds them open so they can drain.
  • Gallstone(s) removal. Gallstones can be removed from the bile duct, but cannot be removed from the gallbladder itself.

Is ERCP Safe?

An ERCP is a low-risk procedure.  However, complications are possible. Such complications include  bleeding, pancreatitis, bowel perforation, and infections. Patients who receive ERCP for treatments such as gallstone removal face increased risk of complications as compared to patients who receive the test only for diagnosis a problem. Prior to the test, your doctor will discuss with you the risks of possible complications.

How Should I Prepare for ERCP?

Prior to having ERCP, inform your doctor of any medical conditions you have, including:

If you use insulin for diabetes, the dosage of insulin may need to be adjusted on the day of the test. Your diabetes care provider will assist in making this adjustment. Bring your diabetes medication to your appointment so it can be taken after the procedure.

If you take blood-thinning medications such as clopidogrel (Plavix), aspirinenoxaparin (Lovenox), dipyridamole (Persantine), or warfarin(Coumadin), your primary doctor may prescribe a different method for thinning your blood prior to the procedure.

Do not discontinue the use of any medication without first speaking about it with your primary or referring doctor.

You may have to take antibiotics prior to the procedure if you:

  • Have an artificial heart valve.
  • Have ever been told that you must take antibiotics prior to a dental or surgical procedure.

Do not eat or drink for eight hours prior to the procedure.

You may feel drowsy after sedation, so it is important that you arrange for a driver to take you home after the procedure. The medication administered during the procedure may cause drowsiness, so you should not drive or operate machinery for eight hours after the procedure.

You may be required to stay overnight in the hospital after the procedure is performed.  Pack any personal items you might need.

What Happens After ERCP?

You will stay in a recovery room for observation for about 1-2 hours. You may feel a soreness in your throat.  You can use throat lozenges to relieve the soreness.

After the procedure, a responsible adult must take you home . It is also recommended to have someone stay with you after the procedure for 24 hours.

You must not drive or operate machinery for at least eight hours.

You should stay overnight somewhere within a 30-minute drive of the hospital in order to get to the emergency room quickly for evaluation, if need be.

The primary or referring doctor will talk to you about the results. If the results show that medical attention is needed promptly, the necessary arrangements will be made, including notifying your referring health care provider.

Warning About ERCP

If you experience any of the following symptoms within 72 hours after the ERCP, call your doctor immediately and seek emergency care:

  • Bleeding or vomiting blood
  • Blood in your stool