What is an ERCP?

ERCP stands for ‘endoscopic retrograde cholangiopancreatography’. ERCP is a very useful procedure as it can be used both to diagnose and treat various different conditions.

An endoscope is a thin, flexible, telescope. It is passed through the mouth, into the oesophagus and down towards the stomach and duodenum. The endoscope contains fibre-optic channels which allow light to shine down so the doctor can see inside.

Cholangiopancreatography means X-ray pictures of the bile duct and pancreatic duct. These ducts do not show up very well on ordinary X-ray pictures. However, if a dye that blocks X-rays is injected into these ducts then X-ray pictures will show up these ducts clearly. Some dye is injected through the papilla back up into the bile and pancreatic ducts (a ‘retrograde’ injection). This is done via a plastic tube in a side channel of the endoscope. X-ray pictures are then taken.

What happens to me during ERCP?

You will require a blood test before ERCP. This will be done usually on the day before or just before, the procedure.

You are taken into the x-ray examination room and asked to lie on your left-hand side. You will see the x-ray and endoscopy equipment around you and the staff wearing x-ray aprons. The amount of x-rays you receive are strictly controlled.

Once in position, your nurse will attach a finger probe, which monitors the oxygen levels in your blood and pulse rate throughout and after the examination.

Sedative drugs make your breathing slow and shallow; therefore we give you a little oxygen via tubes placed in the nostrils.

Sometimes diathermy (gentle cutting with an electrically heated wire) will be used. A special pad will be placed on your leg for safety.

The test usually takes 30 minutes.

Risks

The major risk of an ERCP is the development of pancreatitis, which can occur in up to 5% of all procedures. This may be self limited and mild, but may require hospitalization, and rarely, may be life-threatening. Patients at additional risk for pancreatitis are younger patients, patients with previous post-ERCP pancreatitis, females, procedures that involve cannulation or injection of the pancreatic duct, and patients with sphincter of Oddi dysfunction.

Gut perforation is a risk of any endoscopic procedure, and is an additional risk if a sphincterotomy is performed. As the second part of the duodenum is anatomically in a retroperitoneal location (that is, behind the peritoneal structures of the abdomen), perforations due to sphincterotomies are also retroperitoneal. Sphincterotomy is also associated with a risk of bleeding

Will I ever need an ERCP again?

• This will depend on the reason for the ERCP, what is found and whether it was possible to complete to test.
• It may be necessary to repeat the test after a few weeks if stones have been removed, to check the ducts are clear.
• If it was necessary to insert a stent (tube) into the duct during the test, it may need to be changed or removed at some time.

• Bile – a fluid produced in the liver and passed into the gut via the bile ducts.

• Diagnostic – carried out to find out what is wrong.

• Endoscope – a tube for looking inside the body