Health Encyclopedia

ERCP

Definition

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to identify stones, tumors, or narrowing in the bile ducts. The procedure is done through an endoscope.

Alternative Names

Endoscopic retrograde cholangiopancreatography

How the test is performed

An intravenous (IV) line is placed in your arm. You will lie on your stomach or on your left side for the test. Medicines to sedate you will be given through the IV. Sometimes a spray to numb the throat is also used.

After the sedative takes effect, the endoscope is inserted through the mouth into the duodenum (the portion of the small intestine that is closest to the stomach).

A catheter (thin tube) is advanced through the endoscope and inserted into the pancreatic or biliary ducts. A special dye is injected into these ducts, and x-rays are taken to evaluate them. Narrowing, stones, and tumors can be identified.

Special instruments can be placed through the endoscope 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 is used to identify any abnormality of the pancreas or bile ducts that can cause abdominal pain, jaundice, fever, or malabsorption. These include:

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

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

Side effects of anesthetics used can lead to breathing problems and low blood pressure, but these complications are rare. The risks of the procedure are determined by the treatment it is used for.

There is a risk of bleeding, perforation (hole) of the bowel, and pancreatitis. The risk of having any complication at all is less than 10%, and much lower for having a severe complication (severe pancreatitis, severe bleeding).

Special considerations

Not applicable.

References

Pasricha PJ. Gastrointestinal endoscopy. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 136.

Review Date:3/8/2008
Reviewed By:Christian Stone, MD, Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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