Overview

ERCP (endoscopic retrograde cholangio pancreatogram)

An ERCP is an examination that uses a type of X-ray. It's used to diagnose and treat problems with your bile duct, pancreas and the biliary system.

During the procedure, a flexible tube (endoscope) with a camera on the end is put into your mouth, down your food pipe (oesophagus), into your stomach and the first part of your small intestine.

The biliary system includes your liver, gallbladder, biliary tree, pancreas, pancreatic ducts and bile duct (a tube that drains bile out of the liver into the small intestine)

A line diagram of the biliary system. Labelled to show the location of the liver, gallbladder, biliary tree, stomach, bile duct, pancreas, pancreatic duct, bile duct and duodenum. This diagram is used with permission from EMIS 2009.
A diagram of the biliary system. Labelled to show the location of the liver, gallbladder, biliary tree, stomach, bile duct, pancreas, pancreatic duct, bile duct and duodenum. This diagram is used with permission from EMIS 2009.

Diagnosing

An ERCP allows your doctor to examine conditions of the biliary system.

The doctor can also take samples of your cells through brushings or biopsies during an ERCP. These will be examined in the laboratory to help diagnose any problems you are having.

You might have an ERCP if you have:

  • yellow skin or eyes and itchy skin (jaundice)
  • liver blood tests that need more investigation, and you have tummy (abdomen) pain
  • had a CT or ultrasound scan that shows a blockage in your bile duct or pancreatic ducts

Blockages can be caused by stones, narrowing of the bile duct and growths or cancer of the pancreas or bile duct.

Treatment

An ERCP can be used to treat both the bile duct and the pancreas. It is less invasive than surgery. 

During an ERCP, small plastic or metal tubes called stents can be put into the bile duct. This allows the bile to drain into the intestine.

Stents can also be put into the small intestine (duodenum). This helps people who have a blockage affecting the flow of food out of their stomach.

An ERCP can sometimes be used to help remove pancreatic stones or to put a stent into a narrowed pancreatic duct. This can be helpful in dealing with pain.

Risks of an ERCP

ERCP is generally safe, but there can be some complications. Your doctor will talk about all the risks with you before the procedure.

You will only have an ERCP if your doctor believes the possible risks are better than doing another procedure, or doing nothing.

  • Discomfort in the tummy or a sore throat, which can last a few days.
  • Loose teeth, crowns and dental bridgework can move or fall out when the endoscope tube is put in your mouth. This does not happen often.
  • In some cases, the doctor cannot get to the bile duct or pancreatic ducts to do the ERCP.
  • You might have a sore lump for a few days. This is due to irritation of the vein where medicine was given for the procedure. This is not common.
  • Infection in the bile duct (cholangitis) can occur. Your doctor might suggest antibiotics to treat the infection, which you can have in hospital or at home.
  • If you had a small cut in the bottom of the bile duct (a sphincterotomy) during an ERCP, there is a risk of bleeding. This usually stops quickly without treatment. If it does not stop, you might need an injection of adrenalin through the endoscope tube. In severe cases, a blood transfusion, a special X-ray procedure or surgery might be needed to control the bleeding.
  • Very frail or elderly people can get pneumonia (inflammation or swelling of the lung tissue) after an ERCP. This is due to stomach juices getting into the lung. This happens in about 1 in 500 cases.
  • A hole (perforation) might be made in the wall of the small intestine during an ERCP. This can be due to a sphincterotomy, or a tear made by the endoscope. It happens in less than 1 in 750 cases. You might need surgery to repair the hole. This can be serious, and sometimes fatal.

An ERCP can lead to mild inflammation of the pancreas (pancreatitis). This happens in about 5 in every 100 people having an ERCP.

If you have pancreatitis, you will have pain in your tummy (abdomen), which usually starts a few hours after the procedure and lasts for a few days.

The pain can be controlled with painkillers. You will also be given fluids into a vein (intravenously) in hospital to keep you hydrated.

Some people get severe pancreatitis after an ERCP. This is treated with medicine or surgery. Although it is very rare, severe pancreatitis can be fatal in less than 1 in 500 cases.

Other procedures

SpyGlass ERCP

A SpyGlass is a thin endoscope (cholangioscope) that is passed into the bile duct through the endoscope tube being used. This allows a clearer view of the bile duct.

Specialist equipment can be used to break up bile or pancreatic duct stones using other methods not usually performed during a standard ERCP. It also allows samples to be taken.

Although ERCP is usually the first step to diagnose and treat most bile and pancreatic ducts problems, SpyGlass can be used. This is a longer procedure, and is usually done under general anaesthetic. For this reason, it has a higher risk of side effects or complications.

Your doctor will talk to you about SpyGlass, and if you need the SpyGlass ERCP.

Other treatment options

The only other treatment option is a percutaneous trans-hepatic cholangiogram (PTC). This is a procedure that puts a needle through the skin and into the liver. An X-ray is then used to look at the bile ducts. However, there are more complications with a PTC.

Other ways to diagnose problems

There are other options for diagnosing problems with your biliary system. However, the options below cannot be used to treat the problem. 

  • A CT scan can be used, but this is less sensitive and small growths (less than 1cm) can be missed. Samples (biopsies) cannot be taken during a CT scan, and no stents can be put in to treat the problem.
  • An MRI scan can be used, but this does not allow direct vision of the bile ducts. Biopsies cannot be taken, and no stents can be put in during an MRI scan. You cannot have an MRI scan if you have internal metalwork (such as a pacemaker, or joint replacement).
  • An ultrasound scan can give images of the biliary system, but you cannot have a biopsy, and no stents can be put in.
  • An endoscopy ultrasound (EUS) can be used. However, stones cannot be removed, a sphincterotomy (cut at the base of the bile duct) cannot be performed, and no stents can be put in.

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves. If you would like more information about our consent process, please speak to a member of staff caring for you

Information and support

GUTS UK provide information about diseases and problems that people might have with their digestive system or gut.

Resource number: 2559/VER5
Last reviewed: December 2021
Next review: December 2024

Contact us

If you have any questions or concerns about having an ERCP and you are in hospital, please speak to your nurse.

If you are at home and you have any questions, or you need to cancel or change your appointment, please contact the endoscopy unit.

Phone 020 7188 8887 Monday to Saturday, 9am to 5pm.

You can also contact:

In an emergency

Out of hours (evenings and weekends) phone 020 7188 7188 and ask to be put through to the on-call gastroenterology registrar (via Rota watch).

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Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

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