What happens during the ERCP (endoscopic retrograde cholangiopancreatography) procedure?

After you have received sedation (medication to make you drowsy), a gastroenterologist (a doctor who specializes in the gastrointestinal system) uses a special endoscope (a long, flexible tube with a light and camera at the end) to examine the inside of the digestive system. The gastroenterologist identifies the place where the bile duct comes into the intestine and then feeds a tiny catheter (a plastic tube) into the duct and squirts a contrast agent into the bile system (and sometimes the pancreas) while X-rays are taken. The contrast agent allows the doctors to see the ducts of the bile system, gallbladder, and pancreas on the X-rays.

Once the cause of the problem is identified, the doctor may treat it with one of the following procedures:

  • Sphincterotomy. The doctor makes a small incision (cut) in the opening of the bile duct, which can help small gallstones and bile to drain appropriately.
  • Stent placement. A stent (a plastic drainage tube) is placed in the bile duct and allows it to drain.
  • Removal of the gallstones

Is the ERCP procedure safe?

Like any procedure, ERCP has a small risk of complications, including:

  • An inflammation (swelling) of the pancreas known as pancreatitis
  • Infections
  • A hole in the bowel
  • Bleeding

There may be tenderness or a lump where the sedative was injected, but that should go away in a few days. Some patients need to be hospitalized because of complications, but this is rare.

Your doctor will discuss your risk of possible complications before the test.

How should I prepare for the ERCP procedure?

  • Be sure to tell your doctor if you are pregnant, have a lung or heart condition, or if you are allergic to any medications. Also, tell the doctor if you have an artificial heart valve or if you have ever been told you need to take antibiotics before a dental or surgical procedure. You may need to take antibiotics before the ERCP procedure.
  • If you have diabetes and use insulin, you may need to adjust the dosage of insulin on the day of the test. Your diabetes care provider will help you with this adjustment. Bring your diabetes medication with you so you can take it after the procedure.
  • Tell your provider if you have kidney disease or need dialysis.
  • Tell your provider if you are taking blood-thinning medications such as Coumadin®, aspirin, Persantine®, or Plavix®. Your primary care doctor may prescribe a different method for thinning your blood before the procedure.
  • Do not stop taking any medication without first talking to your primary care doctor or the doctor who referred you.
  • Do not eat or drink anything for eight hours before the procedure.

You will need to bring a responsible adult to the procedure. You should not drive or operate machinery for at least eight hours because the medication given during the procedure may cause drowsiness.

You may need to stay overnight in the hospital after the procedure, so pack personal items you may need.

What happens during the ERCP procedure?

  • Before the procedure, you will be given a hospital gown to wear and you will be asked to remove your eyeglasses and dentures. The doctor performing the procedure will discuss what will happen during the procedure and will explain any risks. If you have any questions, you can ask the doctor at this time.
  • A gastroenterologist who is experienced in ERCP performs the procedure, which lasts from one to two hours. A local anesthetic (pain-relieving medication) may be applied to the back of your throat. You are given a pain reliever and a sedative intravenously (in your vein). You will feel relaxed and drowsy.
  • A mouthpiece is placed in your mouth. It does not interfere with your breathing.
  • You will lie on your left side during the procedure.
  • The gastroenterologist inserts an endoscope through your mouth, down past your stomach, and into the first part of the small intestine (the duodenum). The endoscope does not interfere with your breathing.
  • Contrast dye is injected slowly into the pancreatic or biliary ducts while X-rays are taken. The dye allows the ducts to be seen on the X-rays.

Last reviewed by a Cleveland Clinic medical professional on 08/09/2016.


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