ERCP (endoscopic retrograde cholangio pancreatography)

ERCP stands for endoscopic retrograde cholangio pancreatography. This is a test that uses a type of X-ray. It is used to diagnose and treat problems with your biliary system. 

Your biliary system is made up of organs and ducts (tubes) that produce, store and transport a fluid called bile. This yellow-green fluid helps your body to digest fat.

The biliary system includes your liver, gallbladder, biliary tree, pancreas, pancreatic ducts and bile ducts. Your pancreatic ducts and bile ducts are small tubes. They carry digestive juices from the pancreas and liver to 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.

During the procedure, we put a flexible tube called an endoscope with a camera on the end into your mouth. We then pass this tube down your food pipe (oesophagus). The tube goes into your stomach and the first part of your small intestine (duodenum).

Diagnosing conditions

An ERCP allows us to diagnose and get more information about conditions that affect your biliary system.

During an ERCP, we can take samples of your cells. We do this using a small brush or by taking pieces of tissue (a biopsy). A laboratory examines the cells to help diagnose any problems.

You might need an ERCP if:

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

Possible causes of blockages are:

  • stones
  • narrowing of the bile ducts
  • growths or cancer of the pancreas or bile ducts

Treating conditions

We can do an ERCP to treat conditions that affect the bile ducts, small intestine and pancreas. It is a less invasive procedure than surgery.

  • Bile ducts: During an ERCP, we can put small plastic or metal tubes called stents into the bile ducts if they are blocked. This unblocks the bile ducts and allows bile to drain into the small intestine.
  • Small intestine: We can also put stents into the small intestine (duodenum). This helps if you have a blockage that affects the flow of food out of your stomach.
  • Pancreas: Sometimes, we can use an ERCP to help remove stones in the pancreas or to put a stent into a narrowed pancreatic duct. This can help you to deal with the pain.

Risks of having an ERCP

An ERCP is usually a safe procedure, but there can be some complications. Your doctor talks to you about the risks before the procedure.

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

  • You might get 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 we put the endoscope tube in your mouth. This does not happen often.
  • In some cases, the doctor cannot get to the bile ducts or pancreatic ducts to do the ERCP.
  • For a few days, you might have a sore lump in the place where we put a small plastic tube (cannula). This is due to irritation of the vein that we use to give you medicine for the procedure. It is not common.
  • There is a risk of infection in the bile ducts (cholangitis). 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 your bile duct (a sphincterotomy) during an ERCP, there is a risk of bleeding. This usually stops quickly without treatment. If the bleeding does not stop, you might need an injection of a medicine called adrenalin through the endoscope tube. In serious cases, you might need a blood transfusion (when we give you blood from someone else), a special X-ray procedure or surgery to control the bleeding.
  • Very frail or elderly people can get pneumonia (inflammation or swelling of the lung tissue) after an ERCP. This is because of stomach juices getting into the lung. It 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 tube. 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 cause mild inflammation of the pancreas (pancreatitis). This happens to about 5 in every 100 people who have an ERCP.

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

You can control the pain with painkillers. We also give you fluids into a vein (intravenously) in hospital to keep you hydrated.

Some people get severe pancreatitis after an ERCP. We treat this condition 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 tube (cholangioscope) with a lighted camera. We attach the SpyGlass to the larger endoscope tube used for an ERCP and pass it into the bile ducts. This gives us a clearer view of the bile ducts.

We can break up bile or pancreatic duct stones with specialist equipment. The SpyGlass allows us to use methods that are not normally done during a standard ERCP. We can also take samples (biopsies).

An ERCP is usually the first step to diagnose and treat most bile duct and pancreatic duct problems. However, we can do a SpyGlass ERCP if we need extra information.

A SpyGlass ERCP is a longer procedure than a standard ERCP. You usually have a general anaesthetic, which is a medicine that makes you sleep and stops you feeling pain. For this reason, the SpyGlass ERCP has a higher risk of side effects or complications.

Your doctor talks to you about the SpyGlass ERCP and explains if you need to have this procedure.

Other treatment options

The only other treatment option is called a percutaneous transhepatic cholangiogram (PTC). This is when we put a needle through the skin and into the liver. We then use an X-ray 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, we cannot use these methods to treat the problem. 

  • We can do a CT scan, but this is less sensitive and small growths (less than 1cm) can be missed. We cannot take samples (biopsies) during a CT scan or put in any stents to treat the problem.
  • We can do an MRI scan, but this does not allow us to see the bile ducts directly. We cannot take biopsies or put in stents during this procedure. An MRI scan is not suitable if you have metalwork in your body, such as a pacemaker or joint replacement.
  • An ultrasound scan can give us pictures of the biliary system, but we cannot take biopsies or put in stents.
  • We can do an endoscopic ultrasound (EUS). However, we cannot remove stones, do a sphincterotomy (make a cut at the bottom of the bile duct) or put in stents.

We want to involve you in decisions about your care and treatment. If you decide to have an ERCP, we ask you to sign a consent form. This says that you agree to have the procedure and 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

The charity Guts UK gives information about digestive conditions that affect the gut, liver and pancreas.

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), please phone 020 7188 7188 and ask to be put through to the on-call gastroenterology registrar (through a system called RotaWatch).

Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

Is this health information page useful?