Endoscopic retrograde cholangiopancreatography

Alternative names


Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure used to identify stones, tumors, or narrowing in the bile ducts.

How the test is performed

This test is usually done in the hospital. The throat is sprayed with a local anesthetic. A sedative and pain killer are given through a vein. A special flexible tube (endoscope) is inserted through the mouth into the duodenum (the portion of the small intestine that is closest to the stomach).

A catheter is advanced through the endoscope and inserted into the pancreatic or biliary ducts. A contrast agent is injected into these ducts and x-rays are taken to evaluate their caliber, length and course. Narrowing, stones, and tumors can be identified.

Special instruments can be placed through the scope and into the ducts to open the entry of the ducts into the bowel, stretch out narrow segments, remove or crush stones, take tissue samples, and drain obstructed areas.

How to prepare for the test

You will need to fast at least 4 hours before the test and sign a consent form. Remove all jewelry so that it will not interfere with the x-ray.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

Because of the intravenous sedation, you may not feel any discomfort, and may have no memory of the test. There may be some gagging as the tube is passed down the esophagus. As the scope is positioned, there will be some stretching of the stomach and duodenum. Occasionally, stretching of the ducts can be felt.

Air, used to inflate the stomach and bowel, can cause some bloating or gas. After the procedure, you may have a sore throat for 3 to 4 days. Some people have a bad reaction to the dye or the drugs used to relax the duodenum, which can cause symptoms like nausea, hives, burning sensation, blurred vision, and urine retention.

Why the test is performed

The procedure identifies any abnormality of the pancreas or bile ducts that can cause abdominal pain, jaundice, fever, or malabsorption. These include:

  • Gallstones  
  • Bile duct strictures  
  • Bile duct tumors  
  • Chronic pancreatitis  
  • Pancreatic tumors (including pancreatic cancer)  
  • Pancreatic strictures  
  • Pancreatic pseudocysts

Normal Values
The x-ray will show normal structures for the age of the patient.

What abnormal results mean

Abnormal results may indicate stones or narrowing of the ducts, presence of tumors, cancer, cirrhosis (severe liver disease) and cysts (abnormal cavity filled with fluid or semisolid substances).

Additional conditions under which the test may be performed:

  • Biliary obstruction  
  • Biliary stricture  
  • Cholangiocarcinoma  
  • Cholangitis  
  • Choledocholithiasis  
  • Cholelithiasis  
  • Chronic pancreatitis  
  • Pancreas divisum  
  • Pancreatic carcinoma  
  • Primary biliary cirrhosis  
  • Sclerosing cholangitis

What the risks are

There is a possibility of side effects from the dye and the drug used to relax the duodenum. These may include nausea, hives, blurred vision, or a dry mouth, a feeling of burning or flushing, and retention of urine.

Side effects of anesthetics used may rarely lead to respiratory depression and low blood pressure. The risks of the procedure are determined by the therapy delivered.

If the bile duct opening into the small bowel is enlarged by electrocautery (called a sphincterotomy) there is a risk of bleeding, perforation of the bowel, and pancreatitis. The risk of any complication is less than 10%. Severe complications (severe pancreatitis, severe bleeding) occur less frequently.

Special considerations
Not applicable.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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