This procedure involves placing a small tube through the mouth into the small bowel to evaluate the pancreatic and biliary duct.

This procedure involves placing a small tube through the mouth into the small bowel to evaluate the pancreatic and biliary duct.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that involves placing a small tube, called an endoscope, through the mouth and stomach into the small intestine. A thin tube is then placed through the endoscope into the duct that splits into the pancreatic and biliary ducts. Once there, a dye is injected and x-rays are taken of the duct being evaluated.

  • The x-rays allow the radiologist to see if there is any narrowing, stones, or tumors affecting the ducts.
  • Additional instruments can be placed through the endoscope to enlarge a narrowing, remove any stones, drain an abscess or cyst, or take tissue samples for biopsy.

An ERCP may be recommended if you have abdominal pain, jaundice, fever, or problems with food absorption (malabsorption). Some of the problems may be due to:

  • bile duct or pancreatic narrowing (stricture)
  • bile duct or pancreatic tumors
  • chronic pancreatitis or pancreatic cysts
  • gallstones

Not everybody with symptoms of pancreatic disease needs an ERCP. Your healthcare provider may order an ERCP if he or she strongly suspects pancreatic disease and earlier diagnostic tests do not reveal the source of the problem.

Prior to the procedure, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before the procedure. These may include:

  • medications you should not take before the procedure, such as blood thinners or aspirin
  • regular medications you should continue to take on the day of your procedure
  • how many hours you should stop eating and drinking before the procedure
  • any activity or dietary restrictions you should follow during your recovery

Do not forget to make arrangements for transportation to and from the facility and help at home while you recover.

An ERCP may be done at a facility that specializes in gastrointestinal procedures or at a hospital.

  • Your throat will be numbed before the test and you will be given a medicine to make you sleepy and relaxed (sedative).
  • You may gag when the endoscope is inserted, but any discomfort should be brief.
  • You may have a slight sore throat and gas pains after the test is completed.
  • You will need to stay for a short period of time after the procedure to be sure you are able to drink fluids.

What should I ask my healthcare provider before having an ERCP?

  • What is my diagnosis and reason for the procedure?
  • Will I have any type of sedation? What are the possible side effects?
  • What are the possible risks/complications?
  • Are there any alternatives to this procedure that can provide the information you need with less risk?
  • How will I feel after the procedure and will I have to modify my activity?
  • What symptoms might indicate a problem after the procedure?
  • How many ERCP procedures have you done? How many of your patients have had significant adverse events? How many of them had to remain in the hospital because of complications of an ERCP?

After your ERCP, your healthcare provider should provide a description of any problems found during the procedure and what symptoms you should report. You should also understand all home care instructions (including medications and side effects) and follow-up plans.


Also known as:

Upper Endoscopy
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