ERCP

Reviewed by Dr Alan Ogilvie, gastroenterologist

What is ERCP?

ERCP stands for endoscopic retrograde cholangio-pancreatography. It is an X-ray examination of the pancreatic and bile ducts, which are injected with a dye beforehand to make them show up. The bile ducts drain bile from the liver while the pancreatic duct drains pancreatic juice from the pancreas. Both open into the first part of the small intestine (the duodenum).

When is ERCP used?

The purpose of the examination is to detect any diseases or irregularities in the bile or pancreatic ducts.

The examination may be used to locate, and in some cases remove, gallstones stuck in the bile duct.

It is also possible to reveal cancer, infections and cirrhosis of the liver.

To investigate jaundice where the patient goes yellow as the result of a blockage to the bile ducts.

To investigate otherwise unexplained abdominal pain.

Apart from its diagnostic uses, ERCP can also be used to relieve jaundice by removing gallstones from the bile ducts or by placing a plastic tube (stent) across a narrowing in the lower bile duct.

How is ERCP performed?

An ERCP is carried out in a hospital X-ray department. Because the stomach needs to be empty to allow the the endoscope to pass safely through, the patient has to fast for six hours.

After explaining the procedure, the endoscopist will spray the back of the throat with a local anaesthetic spray similar to that used by dentists that makes the throat feel numb and it may be difficult to swallow.

A sedative drug is injected into the hand or arm. This is not a full anaesthetic but it does make the person being examined feel very sleepy.

A special endoscope is placed in the mouth and the patient is asked to swallow it. It is rather like swallowing a large piece of food.

Although the patient is not usually aware of the procedure after this point, the endoscope is threaded through to the duodenum. Once there, a thin tube will be passed from the endoscope through a small hole in the wall of the duodenum into the ducts which lead to the gall bladder and the pancreas.

The dye is injected into the duct and the X-ray pictures are taken.

The endoscopist will then study X-ray pictures.

If there is a stone in the bile duct, this will be removed by enlarging the lower end of the duct and dragging the stone out.

If there is a narrowing in the bile duct, a plastic tube (stent) will be inserted to allow the bile to drain freely into the duodenum.

After the procedure, the patent will feel sleepy for a few hours. If a stone has been removed or a stent inserted they may need to stay in hospital overnight.

Is ERCP dangerous?

Diagnostic ERCP is perfectly safe. In very rare cases, patients may be allergic to the X-ray contrast dye. There is also a slight risk of inflammation of the pancreas (pancreatitis), which occurs in about 1 per cent of examinations.

Therapeutic ERCP - when it is used for treatment - is the equivalent of a surgical operation and although it is still safe, about 3 per cent of patients may suffer complications. The major ones are infection, bleeding and pancreatitis. Most people recover completely with medical treatment.

In pregnant women, the liquid dyes could damage the baby. Patients suffering from liver, heart or kidney diseases should consult a specialist before taking the test.

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