Endoscopic Retrograde Cholangiopancreatography (ERCP) & Procedure Instructions
ERCP & Procedure Instructions

Endoscopic Retrograde Cholangiopancreatography (ERCP) is used to diagnosis and treat disorders of the pancreas, bile duct, liver and gallbladder. ERCP treatments may include sphincterotomy to treat gallstones or other blockage; stenting to relieve jaundice; nasobiliary tube placement to help the drainage of bile and allow for further X-rays once clear; or rendezvous procedure/transhepatic cholangiogram to allow for the placement of drainage catheters or guide wires.

Endoscopic Retrograde Cholangiopancreatography (ERCP) Instructions
Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS) Instructions

The doctor passes an endoscope (a thin, flexible fiberoptic scope), through the mouth, past the esophagus and stomach, and into the beginning portion of the small intestine/duodenum. The doctor then injects contrast dye into an opening in the small bowel (major or minor ampulla) that leads into the bile ducts or pancreatic duct, to take detailed X-rays or to perform therapeutic maneuvers. Since X-rays are taken, inform us if there is a possibility of pregnancy.

Local anesthetic may be sprayed in your mouth to make it numb, and you will be given medication by injection through a vein to make you sleepy and relaxed. You will also receive intravenous antibiotics to prevent potential infection from the procedure. While you are lying down, the doctor will pass the endoscope through your mouth and down your throat. A dental guard will be placed to protect your teeth. The endoscope will not interfere with your breathing and will not cause any pain. You may be asked to change positions during the examination, assisted by a nurse. The examination usually takes 30 to 90 minutes.

Your throat may feel numb and slightly sore. Because of the local anesthetic and sedation, you should not attempt to take anything by mouth for at least one hour. It is wise to take only clear liquids for the rest of the day.

If you are an outpatient, you will remain in the short stay unit for at least 2 to 3 hours following the procedure. You must arrange for transportation, as the sedation impairs your reflexes and judgment. For the remainder of the day, you should not drive a car, operate machinery or make any important decisions. We suggest rest.

Sphincterotomy: If the X-ray shows a gallstone or other blockage, the doctor can enlarge the opening of the bile duct by making an incision using cautery. This is called a sphincterotomy and is done with an electrically heated wire (which you will not feel). Any stones will be collected into a tiny basket or left to pass into the intestine.

Stenting: A stent is a small plastic tube which is pushed through the endoscope and into the narrowed area of the bile duct. This relieves the jaundice by allowing the bile to drain freely into the intestines. Stents are also sometimes placed into the pancreatic duct when it is narrowed or blocked.

Nasobiliary tube: Sometimes a small plastic tube is left in the bile duct and brought out through the nose. This tube may be left in place for a few days. This helps the drainage of bile and allows for further X-rays to be taken to check when the duct is clear. The presence of the tube may be slightly uncomfortable at first but does not interfere with eating or drinking.

Rendezvous procedure/transhepatic cholangiogram: For a variety of reasons, it is sometimes necessary to request a radiologist (a specialist in X-rays), to perform a transhepatic cholangiogram in conjunction with an ERCP. This procedure involves passing a thin needle through the abdomen into the bile ducts, allowing the placement of drainage catheters, guide wires, etc. At times this can be very useful in difficult cases to make it easier to perform a sphincterotomy, place a stent, perform a dilatation or other procedure. Frequently, the decision whether this procedure will be necessary cannot be made until the patient is sedated, while the ERCP is being performed.

ERCP treatments for stones and blockages have been developed and are recommended because they are simpler and safer than standard surgical operations. However, you should realize that they are not always successful, and problems can arise.

Endoscopy (EGD) can result in complications, such as reactions to medications, perforation of the intestine and bleeding. Injection of contrast dye through the endoscope into the pancreatic duct or bile duct can cause an allergic reaction, inflammation of the pancreas (pancreatitis), and infection of the bile duct (cholangitis). These complications are infrequent but may require urgent treatment, even surgery. Be sure to inform us if you have any pain, fever or vomiting in the 24 hours after ERCP.

It is very unusual for other biliary problems to develop in the months or years after sphincterotomy, but jaundice, fevers and even new stones can infrequently occur. Usually these can be dealt with by a repeat endoscopic procedure.

Please tell us if you have had any other endoscopic examinations or any allergies or bad reactions to medications or contrast dye. You will be asked to sign a consent form giving your permission for the procedure.

Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.