Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is ERCP?

ERCP is an investigation used to view the gallbladder, bile ducts, pancreas, and pancreatic duct. Minor surgery can also be carried out during the procedure. You will be sedated before the procedure and will have little recollection of the event.

How is ERCP performed?

In ERCP, the doctor threads an endoscope (a long, thin, flexible instrument with a light at the end) down your oesophagus (gullet), through your stomach and into the duodenum. The doctor then looks through the endoscope to find the duodenal papilla (ampulla of Vater). This is the point where the pancreatic duct and the common bile duct empty their secretions into the duodenum. After finding the duodenal papilla, the doctor will pass a small plastic tube called a catheter down through the endoscope and use this to inject special dye into the pancreatic and bile ducts. The special dye is a contrast material that shows up on X-rays which the doctor takes. The X-rays can show gallstones or blockages in the bile duct and demonstrate narrowing or blockage of the pancreatic duct.

Gallstones

If the X-rays show a gallstone in the common bile duct, the doctor can remove the stone by inserting a tiny instrument down the endoscope and making a cut through the muscle surrounding the opening of the duct (sphincterotomy). The stone is removed through the cut and collected in a tiny basket or left to pass through the intestine. The basket is removed by pulling it out through the endoscope.

Blockages and narrowing

The X-rays may show a narrowing (called a stricture) or blockage of a duct that is preventing the free flow of bile. In these cases the doctor may be able to insert a device called a stent, via the endoscope. A stent is a narrow plastic tube that is inserted into the duct to hold it open and allow the passage of bile through the duct and into the intestine in the normal way.

Risks associated with ERCP

There is a small risk of complications such as pancreatitis (inflammation of the pancreas), infection, bleeding and perforation of the bowel. Your doctor will discuss the risks of ERCP with you before the procedure.