Endoscopic retrograde cholangiopancreatography, or ERCP, uses two types of tests, an endoscopy and X-ray, to identify and treat abnormalities like strictures (narrowing), gallstones and cysts in your bile and pancreatic ducts, liver and gallbladder.
Your Digestive Health Center doctor also might choose ERCP when anticipating a blocked bile or pancreatic duct during the diagnostic test. Many patients also come to us after an unsuccessful ERCP procedure elsewhere.
Abdominal pain, bloating, enlarged liver or spleen, yellowing of the skin (jaundice) and weight loss are among the reasons your doctor might recommend ERCP. This procedure might also be the next step when stones or a mass in the pancreas or bile ducts are found in an ultrasound or CT scan.
How ERCP Works
Your gastroenterologist, a specialist who treats diseases of the gastrointestinal system, inserts an endoscope – a thin, flexible tube with a camera and light attachment – into your mouth, down to the stomach and into the small intestine (duodenum). Dye is then injected through the endoscope into a small opening known as the ampulla, making the ducts of the pancreas and liver more prominent.
This procedure gives your doctor a precise study of the ducts that drain the liver and pancreas into the bowel as part of the digestive system.
What Type of Treatments Are Available With ERCP?
ERCP is a diagnostic procedure that quickly adapts to becoming a treatment tool when your doctor inserts small instruments through the scope to perform these procedures:
Sphincterotomy: A small incision in the muscles at the openings of the bile duct or pancreatic duct creates more space if, say, your doctor must remove a stone. The cut is usually applied toward the bile duct. In this case, it’s called a biliary sphincterotomy.
Stone Removal: After a sphincterotomy, bile duct stones are removed with balloons and baskets. These stones might have reached the bile duct after forming in the gallbladder. Stones too big to remove are first crushed in a specialized basket.
Stent Placement: Bile or pancreatic ducts narrowed by scar tissue or tumors, blocking normal drainage, can be held open with a small plastic or metal device called a stent. A plastic tube inserted through the ERCP scope into a blocked duct restores normal drainage. A metal stent, a flexible mesh, opens wider than the plastic stent. Both types of stent can clog after several months, requiring a replacement.
Balloon Dilation: Balloons inserted through the ERCP scope widen, or dilate, the narrowed area of the duct. This is a preferred treatment when cancer is not the cause of the narrowing. To maintain the newly widened duct, your doctor might place a temporary stent for a few months.
Tissue Sampling: Tissue samples can determine if narrowing of the bile or pancreatic ducts is caused by cancer. It is much less accurate, however, if the sample does not show cancer.
Digestive Health Center doctors also use these procedures that combine ERCP with another technique:
Rendezvous Technique: Paired with endoscopic ultrasound, which uses high-frequency sound waves to produce detailed images, this procedure allows your doctor to fix an obstruction or attack tumors in places like the bile duct and pancreatic duct. Rendezvous is usually performed when anatomical issues, duct abnormalities or tumors prevent the ERCP scope from accessing the duct.
SpyGlass: This add-on scope has a 6,000-pixel fiberoptic probe attached to a tiny camera that provides a direct, detailed view of the bile duct so your doctor can treat strictures and gallstones. With SpyGlass, we can look into places we could never see before, allowing us to diagnose and treat conditions hiding in the most hard-to-reach areas.
How To Prepare for ERCP
To ensure your stomach is empty, do not eat for at least six hours before the procedure. Your doctor will give you more specifics about fasting as your appointment approaches.
Make sure your doctor knows what medications you take regularly. Some might have to adjusted and others avoided. Also tell your doctor if you use aspirin, vitamin E, nonsteroidal anti-inflammatories, insulin or blood thinners. Are you allergic to any medications or dye used in the procedure? Let your doctor know.
During the procedure, which lasts about an hour, you will receive sedatives through an intravenous line in your arm to keep your body relaxed and numb any pain. It’s important that you not drive or operate heavy machinery the rest of the day. Have a friend or family member drive you home.
An interventional radiologist will review the X-ray images from your procedure. Your doctor will then discuss the results with you and recommend additional treatment, if needed.
Possible Complications of ERCP
Bloating after the procedure is not unusual. It’s a byproduct of air used to inflate the duodenum, the first part of the small intestine just past the stomach, during the procedure. You also might experience minor discomfort from the X-ray dye material injected into the pancreatic or bile ducts.
It's not often that complications result in hospitalization. (An estimated 6 percent to 10 percent of patients require hospitalization.) Pancreatitis, or inflammation of the pancreas, is a typical complication. Some patients experience bleeding, infection, bowel perforation or an adverse reaction to sedative medication.