ERCP: Endoscopic Retrograde Cholangiopancreatography

ERCP is procedure in which a fiber-optic tube is sequentially placed in the throat, esophagus, stomach and duodenum to evaluate the pancreas, main bile duct (the tube that drains the liver and gallbladder) and bile ducts in the liver. The pictures taken during the procedure are performed using an X-ray machine and intravenous sedation such as Versed, Valium or Demerol is administered prior to ERCP.

At the beginning of the procedure, the first test performed might be a motility test that uses a small tube injected with water to examine the pressure of the sphincter of Oddi (the valve that controls the emptying of the bile and pancreas tube). Monitoring devices for oxygen, pulse and blood pressure are in place during the procedure. Although there is a tube in the throat and esophagus, it is very easy to breathe during the procedure.

Benefits of ERCP
The benefits of ERCP are:

  • Possible determination of abdominal pain causes;
  • Possible determination of the cause of increased liver enzymes;
  • If an obstruction is present, such as a stricture or gallstone, pictures can be taken and therapy applied;
  • Removal of gallstones through a basket or balloon device;
  • If the bile or pancreas tube is blocked, a surgical/cautery cut can be made (sphincterectomy) to open the valve and allow emptying;
  • Assessment of pancreatitis causes;
  • If there is a blockage of pancreas drainage, a surgical/electrocautery cut can be made that may aid drainage and decrease the recurrence of pancreatitis;
  • If an autoimmune condition such as primary sclerosing cholangitis (PSC) is present, the extent of disease may be documented;
  • If a stricture or narrowing of the bile duct is present, a balloon device may be inflated to open the stricture;
  • Biopsies and brushings to document the presence or absence of cancer if the disease is suspected;
  • Drainage of the liver or pancreas by placing a stent (plastic of metal tube) if a major obstruction is present.


Risks of ERCP
The risks of ERCP include:

  • Development of pancreatitis in 1% to 3% of patients. Pancreatitis is an inflammatory condition of the pancreas that can result in a prolonged hospitalization in one out of seven patients and may rarely result in repeated surgeries or even death (less than one in 500-1,000 patients).
  • Complications such as bleeding, perforation and respiratory problems (all rare) and a sore throat.


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