Endoscopic retrograde cholangiopancreatography (ERCP)

This is a specialist endoscopic procedure used to investigate and treat problems that affect the pancreas and biliary system. These include jaundice (which causes the skin to become yellow), abnormal liver tests, abdominal pain and other digestive symptoms. These problems can be due to a range of conditions that may cause blockages within the bile duct or pancreatic duct, including gallstones or tumours.

Why is ERCP performed?

• It allows treatment of any blockage of the bile or pancreatic ducts; during ERCP it is possible to remove stones, to widen strictures and to insert drainage tubes (plastic or metal stents) as necessary.
• It allows samples to be taken from within or around the bile duct that can then be analysed further as part of your diagnosis.
• It is sometimes used to provide a detailed assessment of the muscles that control how well bile and pancreatic juices drain into the intestine. This technique, called manometry, shows if the muscles in the wall of the duct are prone to spasm.

Before and after an ERCP

• ERCP is a safe and well tolerated procedure, with >95% of patients experiencing no ill effects. Your procedure will be performed by some of the most experienced specialists in the UK. Potential side effects will be discussed with you in detail beforehand when you give your consent, but you should feel able to discuss any worries at any point prior to ERCP.
• Some blood thinning medications such as aspirin, clopidogrel or warfarin may prevent us from performing some procedures during an ERCP. Please tell your gastroenterologist if you are taking these drugs, as they may need to be stopped or adjusted for up to one week before your procedure.
• Blood tests are essential within a week or two before you have an ERCP; these include liver function tests, a full blood count and clotting tests.
• You must not eat for at least 6 hours before an ERCP procedure. You can drink clear liquids (tea or coffee with no milk, or water) up to two hours beforehand.
• Many patients stay overnight following an ERCP to allow close observation. It is sometimes possible to go home on the same day (usually over 4 hours after the procedure). It is important to arrange for a friend or relative to take you home afterwards, as you will not be able to drive, and you are strongly advised not to go home unaccompanied.

The ERCP procedure

You will be asked to dress in a hospital gown, and a thin cannula will be inserted into a vein in your hand or arm (this will be used to give sedatives into the blood stream). You may be given an antibiotic to take one hour before the ERCP. ERCP is a more complex procedure than other forms of endoscopy, and so is always performed under sedation.

When in the endoscopy room you will be asked to lie on your front, with your face to the right. Oxygen may be given through small rubber prongs into your nose, and a finger probe will be used to monitor your heart rate, and the oxygen in your blood. You may be given a throat spray and a sedative, painkiller and muscle relaxant will be given into the vein. A mouth guard will be put into your mouth to protect your teeth.

During the ERCP, a specialist endoscopist will insert a thin flexible telescope through your mouth, down the oesophagus and stomach and into to the duodenum, the section of small intestine that lies beyond the stomach. Thin catheters and wires may then be carefully passed into the bile duct or pancreas through the ampulla, on the side of the duodenum. This then allows Xray dye to be injected, and treatment to be performed.