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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.

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 relax or sedate you will be given through the IV. Sometimes a spray to numb the throat is also used. A mouth guard will be placed in your mouth to protect your teeth. Dentures must be removed.

After the sedative takes effect, the endoscope is inserted through the mouth, and passed through the esophagus (food pipe) and stomach until it reaches the duodenum (the part of the small intestine that is closest to the stomach).

A catheter (thin tube) is passed through the endoscope and inserted into the tubes (ducts) that lead to the pancreas and gallbladder. A special dye is injected into these ducts, and x-rays are taken. This helps the doctor see stones, tumors, and any areas that have become narrowed.

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
• Drain blocked areas

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.

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.

The procedure is used to identify any problems of the pancreas or bile ducts that can cause abdominal pain (usually in the right upper or middle stomach area) and yellowing of the skin and eyes ( jaundice). These include:

• Bile duct strictures
• Bile duct tumors
• Chronic pancreatitis
• Gallstones
• Primary biliary cirrhosis
• Cholangitis
• Pancreatic pseudocysts
• Pancreatic strictures
• Pancreatic tumors (including pancreatic cancer)

ERCP is often performed after gallstones in the common duct are discovered during cholecystectomy.

A procedure called endoscopic sphincterotomy (ES) can be done at the same time as an ERCP.

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

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

Reactions to the anesthesia, dye, or drug used during this procedure may include

• Blurred vision
• Breathing problems
• Dry mouth
• Feeling of burning or flushing
• Hives
• Low blood pressure or slow heart rate
• Nausea
• Throat spasm
• Urine retention

Risks related to the procedure include:

• Bleeding
• Perforation (hole) of the bowel
• Inflammation of the pancreas (pancreatitis), which can be very serious

Long-term complications include:

• Return of stones
• Abscess

Endoscopic retrograde cholangiopancreatography; Papillotomy; Endoscopic sphincterotomy

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

Updated by: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by George F Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California.