Endoscopic retrograde cholangiopancreatography; a procedure in which a specialized endoscope is advanced into the duodenum to visualize and treat the bile and pancreatic ducts.
Indication
- Obstructive jaundice and cholangitis (bile-duct infection) caused by bile-duct stones
- Bile-duct narrowings (benign or malignant strictures)
- Pancreatic-duct stones or strictures and complications of chronic pancreatitis
- Brush cytology or biopsy when bile-duct or pancreatic cancer is suspected
- Treatment of postoperative bile leaks (stent placement)
- Drainage of pancreatic cysts and pseudocysts
Preparation
- No food or drink for 6-8 hours before the procedure
- Adjustment of blood thinners with physician approval
- Coagulation tests, liver and pancreatic enzymes, blood type, and a recent complete blood count
- MR cholangiography (MRCP) or CT imaging is often requested before the procedure
- Intravenous antibiotic prophylaxis is started before the procedure when indicated
How it's performed
- The patient is brought to a fully equipped endoscopy unit similar to an operating room
- Deep IV sedation is administered, or general anesthesia if needed
- A side-viewing endoscope is advanced through the mouth into the duodenum
- The common opening of the bile and pancreatic ducts (papilla) is identified, cannulated with a fine catheter, and contrast is injected
- The ducts are imaged under X-ray; stone removal, balloon dilation, or stent placement is performed when needed
- Therapeutic steps such as sphincterotomy (cutting of the papilla), stone extraction with basket or balloon, and brush biopsy may be performed
Post-procedure
- The patient remains fasting for 4-6 hours after the procedure; an overnight hospital stay is recommended
- Close monitoring for abdominal pain, fever, or vomiting
- Blood tests (amylase, lipase) are checked after the procedure
- If a stent was placed, removal or replacement is planned in 6-12 weeks
- Pathology results and the next treatment plan are reviewed by a multidisciplinary team
Risks
- Post-ERCP pancreatitis (about 3-5%, mostly mild to moderate)
- Bleeding related to sphincterotomy (1-2%)
- Bile-duct infection (cholangitis) and sepsis
- Bowel or bile-duct perforation (less than 1 in 1,000)
- Cardiopulmonary risks related to sedation or anesthesia
FAQ
Is there an alternative to ERCP?
If only diagnosis is needed, MRCP (magnetic resonance cholangiopancreatography) is often sufficient and is non-invasive. ERCP is preferred when treatment such as stone removal or stent placement is required.
Is abdominal pain after the procedure normal?
Mild discomfort can occur. However, severe and persistent abdominal pain, fever, or vomiting may indicate pancreatitis or another complication and should be reported to your doctor without delay.
How long does a stent stay in place?
Plastic stents are usually replaced or removed within 6-12 weeks. A timely follow-up is needed to reduce the risk of stent occlusion.
Is hospital admission required?
Because of possible complications such as pancreatitis, most centers recommend at least one night of observation. Admission is mandatory when general anesthesia is used.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Liver Disease Monitoring
Internal Medicine Outpatient Services
Liver disease monitoring — comprehensive follow-up and treatment management for viral hepatitis, fatty liver, and cirrhosis.
Hepatitis Monitoring and Treatment
Internal Medicine Outpatient Services
Hepatitis monitoring and treatment — current antiviral therapy and liver follow-up process for chronic hepatitis B and C.
Liver Biopsy
Internal Medicine Outpatient Services
Liver biopsy — diagnosis through a small tissue sample taken from the liver with a fine needle under ultrasound guidance.
Diabetes Monitoring
Internal Medicine Outpatient Services
Diabetes monitoring — glycemic control, organ protection, and lifestyle management for diabetes mellitus.
General Health Check-up
Internal Medicine Outpatient Services
Check-up — systemic screening in adults for risk assessment and early diagnosis.
Autoimmune Disease Monitoring
Internal Medicine Outpatient Services
Autoimmune diseases — diagnosis and long-term follow-up using markers such as ANA and anti-CCP.
Rheumatic disease follow-up
Internal Medicine Outpatient Services
Rheumatic disease follow-up — diagnosis, treatment, and monitoring service for joint, connective tissue, and autoimmune diseases.
PEG
Internal Medicine Outpatient Services
PEG — endoscopic placement of a feeding tube through the abdominal skin into the stomach in patients who require long-term nutrition.