What is ERCP?

ERCP is a highly sophisticated technique requiring special endoscopic training and can be accomplished successfully in a high percentage of patients. A long, flexible tube, slightly thinner than a pen, is passed through the mouth and back of the throat into the duodenum (the first portion of the small intestine). The opening from the bile duct and pancreatic duct into the duodenum is identified. A small plastic tube called a cannula is then passed through the endoscope into this opening and directed into the bile duct and/or pancreatic duct. Contrast dye is injected, and then X-rays are taken to study the ducts.

What preparation is required?

For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, from 11 p.m. the evening before the examination or for at least six hours before its performance. For more specific instructions, please read our ERCP instructions document. Your doctor will be more specific about the time to begin fasting, depending on the time of day your ERCP is scheduled. Be sure to let your doctor know if you are allergic to any drugs or if you have had an allergic reaction to iodine dyes.

A companion must accompany you to the examination because you will be given medication to help you relax. It will make you drowsy, so you will need someone to take you home. You will not be allowed to drive after the procedure. Even though you might not feel tired, your judgment and reflexes might not be normal.

It is important that your doctor knows if you have had any barium X-rays in the past week, as barium might interfere with this test. Please bring your X-rays with you because they might be important.

What can I expect during the procedure?

You will be given medication through a vein to make you relaxed and sleepy, and your throat might be sprayed with local anesthetic. While you are lying in a comfortable position on an X-ray table, the ERCP endoscope will be inserted through the mouth and into the duodenum. During the procedure, while X-rays are being taken, you might be asked to change your position.

The tube will not interfere with your breathing. Gagging is usually prevented by the medication. During the procedure, you may feel bloated due to the air used to inflate the intestine. When X-ray contrast material is injected into the ducts, you may feel some discomfort.

What can I expect following the procedure?

You will be observed in the endoscopic area until most of the effects of the medication have worn off. You might feel bloated and might have a soft bowel movement because of the air and contrast material that were introduced during the examination.

You will be able to resume your diet after the procedure unless you are instructed otherwise.

What risks are involved with ERCP?

ERCP is safe and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this highly specialized procedure. Complications can occur but are uncommon.

One possible complication is pancreatitis due to irritation of the pancreatic ducts by the X-ray contrast material. Another possible complication is infection.

Localized irritation of the vein might occur at the site of medication injection. A tender lump develops that might remain for several weeks to several months but goes away eventually.

Other less common risks include perforation (tear) of the bowel, drug reactions, and complications from unrelated diseases such as heart attack or stroke.

Death is extremely uncommon but remains a remote possibility.

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