What is ERCP and why is it performed?

Endoscopic retrograde cholangiopancreatography, or ERCP, is technique used to study and treat conditions of the bile duct, pancreatic duct and gallbladder. The bile duct and pancreatic duct are tubes that drain the liver and pancreas respectively into the small bowel.

The most common reasons to undertake ERCP is to remove a gallstone that is stuck in the bile duct or to treat blockage of the bile duct causing jaundice.

What preparations are required?

An empty stomach is required for ERCP to be undertaken safely. Preparation is similar to Gastroscopy.

How is ERCP performed?

During ERCP, your doctor will pass an endoscope through your mouth, oesophagus and stomach into the duodenum (first part of the small bowel). An endoscope is a thin, flexible tube that lets your doctor see inside your bowels.

After your doctor identifies the opening of the bile duct in the duodenum, they will use a cannula (plastic tube) to inject dye into the bile duct or pancreas duct and obtain x-rays of the ducts.

In the cases where a gallstone is identified within the bile duct, a small cut is made to enlarge the opening of the bile duct and and the stone is pulled out of the bile duct and allowed to pass through the bowel. Sometimes if there is bile duct blockage, a plastic or metal tube (stent) may need to be inserted into the bile duct to allow the bile to drain normally.

What can I expect during ERCP?

Your doctor will first discuss the risks of the procedure with you and address any questions you may have. You will then meet your anaesthetist who will discuss all aspects of the anaesthetic. Following this you will be taken to the procedure room. You'll then lie on your stomach, and a needle will be placed in your hand or arm. This is used to administer the anaesthetic. Once you are completely asleep your doctor will pass the endoscope through your mouth and into the duodenum. The procedure usually takes around 30-60 minutes.

What are possible complications of ERCP?

ERCP is an extremely safe procedure when performed by doctors who are specially trained and experienced in the technique. ERCP does carry significantly higher risks compared to other endoscopic tests such a gastroscopy or colonoscopy.

The most common complication after ERCP is pancreatitis which occurs up to 1 in 10 to 1 in 20 patients. This usually manifests as abdominal pain and usually settles with a period of bowel rest/fasting for 24-48 hours. Pancreatitis may occasionally require admission to hospital and rarely may lead to life threatening complications. Other risks of ERCP include bleeding, infection of the bile duct and rarely perforation (or tear) of the lining of the gastrointestinal tract. Perforation is rare (1 in 500 to 1 in 1000) however is a serious complication that usually requires surgery.

Although serious complications after ERCP are uncommon, it's important to recognise complications and treat them early.

Contact your doctor immediately if you have a fever after the test or if you have persistent abdominal pain, or bleeding, including black stools. If you have any concerns following your test, you should contact your doctor right away.

What can I expect after ERCP?

If you have ERCP as an outpatient, you will be observed for complications before being sent home. You can resume fluids usually 4 hours following the test and a normal diet the folllowing day unless you are instructed otherwise.