Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is Endoscopic retrograde cholangiopancreatography?

Endoscopic retrograde cholangiopancreatography is a treatment method used to diagnose and treat disorders related to the pancreatic and biliary ductal systems as well as the liver, gallbladder, and pancreas. The treatment technique combines endoscopy and fluoroscopy, live X-ray.

Indications of Endoscopic retrograde cholangiopancreatography

Some of the indications for ERCP include:

  • Treating blockage in the bile or pancreatic ducts due to gallstones, strictures, cancer, or compression from nearby tissues.
  • Jaundice (yellowish skin due to blockage of the bile duct)
  • Persistent or recurrent upper abdominal pain which cannot be diagnosed by other tests such as MRCP/MRI, CT
  • To confirm diagnosis of pancreatic or bile duct cancer and plan treatment


  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • Inform your doctor if you have a history of allergy to any medication, anaesthetic, or contrast agent.
  • Avoid eating and drinking for 8 hours before the procedure.
  • Arrange for someone to drive you back home after the procedure

Procedure of Endoscopic retrograde cholangiopancreatography

  • You will be asked to lie on an examination table for the procedure.
  • The procedure may be performed under sedation and local anaesthesia or general anaesthesia. An intravenous (IV) needle will be placed in your arm.
  • After administering a local anaesthetic to the throat, your doctor will insert an endoscope through your mouth, oesophagus, and stomach to reach the first part of the intestine called the duodenum where the bile and pancreatic ductal systems open. 
  • A small camera mounted on the endoscope captures images which are magnified and viewed on a monitor.
  • Your doctor will locate the opening where the bile and pancreatic ducts empty into the duodenum.
  • A catheter will be inserted through the endoscope into the ducts and a special dye, called a contrast medium, will be injected into the ducts through the catheter to make the ducts more visible on x-rays.
  • Fluoroscopy (live X-ray imaging) is performed to identify areas of blockage or other abnormalities.
  • Your doctor may then pass tiny tools through the endoscope to open blocked or narrowed ducts and remove or break gallstones.
  • Temporary stents may be inserted to keep ducts open or to avoid bile leaks that can occur after gallbladder surgery.
  • The procedure often takes between 1 and 2 hours.

Post-operative Care

You will be transferred to the recovery area until the anaesthesia wears off. You may experience a sore throat and minor cramps. You can resume eating the next day following the procedure.

Risks and Complications

Some of the risks and complications for endoscopic retrograde cholangiopancreatography include:

  • Infection
  • Inflammation of the pancreas or gallbladder
  • Excessive bleeding
  • Duct perforation or damage to the small intestine, oesophagus, or stomach
  • The Clementine Churchill Hospital
  • NHS Royal Free London
  • UCL
  • NHS London North West
  • Royal College of Surgeons of England