Endoscopic Retrograde Cholangiopancreatography: Uses, Risks


Endoscopic Retrograde Cholangiopancreatography (ERCP) is a combination of upper gastrointestinal (GI) endoscopy and x-rays. It is used to find and treat abnormalities in your pancreas, bile ducts, and gallbladder.


ERCP will be performed if your bile or pancreatic ducts are narrowed or blocked because of:

  • Gallstones
  • Infection
  • Acute pancreatitis
  • Chronic pancreatitis
  • Trauma or surgical complications in your bile or pancreatic ducts
  • Pancreatic pseudocysts
  • Tumors or cancers of the bile ducts
  • Tumors or cancers of the pancreas


Before an ERCP, your doctor will usually ask you to fast beforehand because an empty stomach will make it easier to see your GI organs. Smoking or chewing gum should also be avoided.

If you are taking any medications, you need to let your doctor know. You may need to stop taking medications that contain aspirin or other blood thinners. These medicines include:

You should tell your doctor about any food and drug allergies you have. If you had bad reactions to contrast dye in the past, let your doctor know as well.

How to perform

The exact steps of ERCP include:

  • Sedation

In order to perform the procedure well, a sedative will be provided through an intravenous needle placed in your arm. With sedatives, you can stay relaxed and comfortable during the procedure. In addition, a health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat so that gagging can be prevented. Sometimes, general anesthesia may be needed.

  • Endoscopy

After you lie down on an X-ray table, the gastroenterologist will feed the endoscope down your esophagus to your stomach and the upper part of your small intestine. A tiny camera attached to endoscope will send a video image to a monitor. The endoscope also pumps air into your stomach and duodenum so that they can be seen more easily.

  • Catheterization and contrast dye

In this step, your doctor will put a catheter into a small opening which connects your bile ducts with your duodenum (called the papilla). Then, contrast dye will be injected through it in a retrograde, or backward flow, pattern. This fluid can highlight the ducts to make them more visible on an X-ray. It will be carried by the catheter to the pancreatic or biliary ducts.

  • X-ray

Due to the contrast dye, any abnormalities such as narrowed areas, scar tissue and blockages will be revealed on the X-ray images. By viewing these images at a later date, the doctor will decide what to do next.

  • Fluoroscopy

Abnormalities are typically treated during ERCP. X-ray video, also called fluoroscopy will enable your doctor to see the ducts and carry out treatment. A tiny tube called a stent may be placed into the duct through the endoscope to treat strictures. Gallstones also can be removed or dissolved through the endoscope.

  • Recovery

After the procedure, you need to recover in a room. When the sedative wears off, you can go home. Considering that you will feel tired, you had better have someone to give you a ride.


According to a research, about 5 to 10 percent of people who undergo ERCP procedure have complications. These complications include:

  • Pancreatitis
  • Infection of the bile ducts or gallbladder
  • Excessive bleeding, called hemorrhage
  • An abnormal reaction to the sedative
  • Perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into it.
  • Tissue damage from x-ray exposure
  • Death

Keyword: Endoscopic Retrograde Cholangiopancreatography; ERCP.

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.