ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that uses X-rays and an endoscope to view, diagnose, and treat problems in the bile ducts, pancreas, liver, and gallbladder.

The liver makes bile, a chemical that helps with digestion. Long narrow tubes called bile ducts transport bile to the gallbladder, where it is stored until needed. When you eat, the bile ducts then carry bile from the gallbladder to the duodenum, or first part of the small intestine, where food is liquefied and nutrients are absorbed. The pancreas is a large gland that produces the hormone insulin and other chemicals that help with digestion.

Your doctor may perform ERCP to diagnose problems that can interfere with this process and cause abdominal pain, such as gallstones, tumors, or narrowing (strictures) in the bile ducts. He or she may also use ERCP to diagnose pancreatic disease, including pancreatitis and cancer.

How to Prepare for an ERCP

You should not eat or drink anything after midnight prior to the procedure. Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

What to Expect

ERCP is performed during an upper endoscopy. A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. You will lie on your left side on a special X-ray (fluoroscopy) table and receive sedation through an IV line to relax you and make you feel drowsy. The doctor will insert the endoscope through the mouth, passing it down through the esophagus and stomach into the duodenum (the first part of the small intestine).

The doctor then passes a cannula through the endoscope and inserts it into the bile ducts that lead to the pancreas and gallbladder. A contrast dye is injected through the cannula into the ducts and X-rays are taken. This helps the doctor see stones, tumors, or strictures.

If the doctor finds an obstruction in the bile ducts, he can insert special instruments through the endoscope and into the ducts to remove stones, drain blocked areas, or stretch out (dilate) any narrowed areas. If the doctor finds a tumor, she can take a biopsy for testing in a lab.

ERCP usually lasts anywhere from 30 minutes to 2 hours, depending on any treatments the doctor needs to perform.