Endoscopic Retrograde Cholangiopancreatography (ERCP) is a test designed to study the biliary system and pancreas. It is performed when the doctor suspects there may be a blockage of the bile ducts (tubes) that travel from the liver to the small intestines or a problem with the pancreas which also drains into the small intestines. These blockages can be due to a number of benign conditions such as gallstone disease or scarring in the ducts, but they can also be due to tumors. Many years ago, ERCP was performed primarily to diagnose these problems involving the bile ducts and pancreas, but now there are other methods to diagnose the problems (for example, MRI) and the ERCP is usually done most often to treat the problems.
An ERCP is performed by passing a small tube with a camera (endoscope) through the patient’s mouth, esophagus, and stomach, into the small intestines where the bile duct and pancreas duct drain. A small tube called a catheter is then passed through the endoscope and advanced into the bile duct or pancreas duct. Contrast dye is injected through the catheter so the ducts can be seen on X-ray imaging. Depending on the findings, the doctor may elect to cut the opening of the ducts (papilla) so stones can be removed from the duct. In some cases, a tube called a stent may be left in the duct at the end of the procedure to allow bile to drain.
ERCP is usually performed on a patient that has been fasting for a minimum of 6 hours. It is necessary to stop taking medications that can cause blood thinning — Aspirin, Coumadin, or medications such as Plavix — for several days before the test. Although patients usually go home following an ERCP, the doctor may decide to keep you in the hospital for observation or further therapy afterwards. Potential complications of the procedure include the standard risks of all endoscopic procedures such as bleeding, infection, reaction to sedation or perforation. A unique risk of this procedure is pancreatitis, or inflammation of the pancreas. On occasion, the procedure is not successful and further tests are needed. The doctor will discuss these issues with you before the procedure.