ERCP (Endoscopic Retrograde Cholangiopancreatography)

ERCP is a procedure that blends endoscopy and X-ray technology to treat conditions affecting the bile and pancreatic ducts. Using a technique many call an “upper GI”, a flexible scope or camera travels down through a patient’s mouth to the stomach and upper areas of the small intestine where doctors can evaluate or treat a variety of conditions. Many patients don’t have an ERCP just for exploration, but to treat a problem.

ERCP is used to treat blockages or narrowing of the bile and pancreatic ducts related to:

• Tumors
• Gallstones
• Infection
• Scarring
• Faulty valves
• Inflammation from trauma or illness (such as pancreatitis)

The Procedure

Patients should not eat or drink for 6-8 hours before an ERCP and may need to stop taking some medications before the test. These include blood thinners, NSAIDs (like ibuprofen or naproxen), high blood pressure medications, diabetes medications and others. Patients should discuss all medications with their physician prior to the procedure.

Patients are given light sedation during an ERCP. To start the process, the doctor will begin by introducing a flexible scope (endoscope) down the patient’s mouth and into the stomach or duodenum—the beginning of the small intestine. The physician will be able to visualize structures inside the body as the camera relays them to a computer screen. Once the doctor locates the bile and pancreatic ducts, a thin tube is passed down through the endoscope and dye (contrast dye, or X-ray dye) is added. A series of X-rays are then taken to see where the ducts are clogged or narrowed so treatment can begin.

Once problem areas are identified, X-ray video, or fluoroscopy is used to guide the removal or treatment of any blockage(s). Tumors and gallstones can be removed with this method. Biopsies of tissue from the area can also be collected and tested for the presence of cancer or infection.

Risks

Risks associated with an ERCP can include:

• Bleeding
• Infection
• Pancreatitis
• Swallowing problems
• Fever
• Puncture of the GI tract or ducts

Risks for complications related to an ERCP are lower when performed by an experienced physician. Average complication rates are between 6 and 10 percent overall.