Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography is a procedure that combines upper GI endoscopy and x-rays and allows the physician to evaluate the bile ducts and pancreatic duct. Gallstones in the bile duct can be removed during this procedure, biopsies may be taken, and other abnormalities of the bile and pancreatic ducts may also be treated, including placing stents to reopen ducts. The procedure is done at Fletcher Allen Health Care and takes about 30-60 minutes, with the entire outpatient visit typically lasting about 2-3 hours.

Before the procedure begins, the patient is given a local analgesic that numbs the throat and calms the gag reflex. Conscious sedation or deeper sedation is delivered via an IV line. 

The endoscope is inserted into the mouth, and then advanced gently down the esophagus, through the stomach and into the duodenum (the first part of the small intestine). Air is introduced through the endoscope to inflate the stomach and duodenum, making them easier for the physician to examine.

When the doctor locates the duodenal papilla, a catheter is slid through the endoscope and guided through the papillary opening. Once the catheter is inside the papilla, the doctor injects a dye into the ducts. The dye allows the ducts to be seen on x-ray video (fluoroscopy), which will reveal narrowed areas or blockages.

After the procedure, patients rest in the recovery room for an hour while the sedative wears off. Driving is not allowed for 12 to 24 hours, so patients will need a ride home.

Resting for the remainder of the day is advised. Patients may feel bloated or nauseous. Any soreness in the throat disappears within 24 to 48 hours. Regular activities may be resumed the following day.

The upper GI tract must be completely empty before an ERCP.  Complete instructions for prepping for an Upper GI Endoscopy/ERCP/EUS should be reviewed well in advance of the procedure. Patients with certain health conditions may require special instructions. Please refer to the instructions on the right side of this page.

Although quite rare, most complications are related to sedation administration (cardiac and respiratory problems);  Rarely, perforation, bleeding, or infection may require additional treatment such as hospitalization and/or blood transfusions.