ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is the procedure of imaging the bile ducts and the pancreatic duct with the help of an endoscope, and of treating them in the same session where that is needed. The name describes how it is done: the doctor goes in with an endoscope (endoscopic), contrast is passed up the ducts against the direction of flow (retrograde), and the bile ducts (cholangio-) and pancreatic duct (pancreatography) are shown on X-ray.

Today ERCP is done largely for treatment rather than for diagnosis. If the bile ducts only need to be looked at, MR cholangiography (MRCP) is preferred, because it gives the same information without anything being done to the patient.

When is it needed?

• Removing stones that have passed into the bile duct
• Opening narrowings in the bile ducts and placing a stent
• Relieving obstructive jaundice caused by a tumour
• Treating bile leaks
• Stones and narrowings of the pancreatic duct in chronic pancreatitis
• Taking brushings or biopsies from a suspect narrowing

How do you prepare?

Nothing is eaten for 6–8 hours beforehand. A full blood count and clotting tests (prothrombin time / INR) are asked for.

Tell the doctor without fail about blood-thinning drugs, drugs for diabetes, and any drug allergies. Say so too if you have heart valve disease or a pacemaker.

Consent form

The clinic’s consent form will be signed.

How is it done?

The procedure is done in a room with an X-ray machine, under sedation or general anaesthesia. A special side-viewing endoscope (a duodenoscope) is passed through the mouth to the duodenum, to the papilla — the shared opening of the bile and pancreatic ducts.

A fine catheter is passed through that opening into the duct and contrast is injected so that films can be taken. If need be, the mouth of the papilla is widened by cutting it with a special wire (endoscopic sphincterotomy); stones are drawn out with a balloon or a basket, and a stent is placed where there is a narrowing.

The procedure generally takes 30–60 minutes.

Afterwards

After a successful procedure the patient is generally watched for a few hours; depending on what was done, a night in hospital may be asked for. Abdominal pain, fever or vomiting should be reported at once.

What are the risks?

ERCP carries one of the higher complication rates among endoscopic procedures, and for that reason it is only done when it is genuinely needed. The main ones are:

• Post-ERCP pancreatitis — the commonest complication
• Bleeding from the sphincterotomy
• Infection of the bile ducts (cholangitis)
• Perforation — uncommon

Your doctor will weigh the benefit the procedure will bring you against these risks.