Endoscopic Retrograde CholangioPancreatography (ERCP)

ERCPEndoscopic Retrograde CholangioPancreatography (ERCP) is an endoscopic procedure that is used to treat conditions relating to the bile duct that drains the liver into the bowel. It is always done with sedation and pain relief, but can be done as a day case procedure. This procedure is used to:

  • Remove gallstones from the common bile duct (but not the gallbladder)
  • Relieve jaundice that is caused by obstruction to the outflow of the liver from a benign or malignant stricture or narrowing

As you will have been seen in clinic beforehand, sedation will have been discussed with you already. The sedation that is used for colonoscopy is midazolam that is given to you through a canula (plastic tube inserted into a vein in your arm prior to the procedure). This is a short acting sedative that will generally make you drowsy and also forget what is happening during the procedure. In the doses that are used for endoscopy, it is generally safe with very few side effects. The pain relief that is used is pethidine given through the canula. If you are allergic to this, there are alternatives that can be used, but please tell me in advance. Buscopan is also used in this procedure to relax the bowel. It is a safe drug, but cannot be used if you have glaucoma (an eye condition). Please tell me in advance if this is the case.

As ERCP uses a combination of Endoscopy and X-rays, it is important for female patients to be clear that they are not pregnant.

On the day of the procedure, you will need to be starved of food for 6 hours prior to your appointment with only clear fluids (water, black tea etc) up to 2 hours prior to the procedure.

During the procedure, you will be positioned on an x-ray table and a mouth guard placed between your teeth. Once the sedation has had an effect, the scope is passed until it is placed in front of the opening to your bile duct. A number of instruments can be passed through the scope to access the bile duct and undertake therapy to remove stones or place a stent (to relieve the obstruction from a blockage).

The procedure lasts upto 45 minutes. It is a safe test, but there are specific risks that you will have been made aware of in advance of the day of your procedure.

ERCP is a very safe procedure and complications and adverse events are rare. Complications that could occur include perforation (causing a tear in the gullet or stomach) and this may require either medicines or surgery if it were to occur. Bleeding also rarely occurs and this is more likely if you are taking medicines to thin the blood such as warfarin or clopidogrel. It is important that you tell me and the nursing staff about the medications that you are on.

It is possible to introduce infection into the bile duct, but as long as the bile duct is draining well at the end of the test, then this is very unlikely. In certain circumstances, I may give an antibiotic prior to the procedure starting.

The major risk of ERCP is pancreatitis (inflammation of the pancreas which is closely related to where I would be working). The risk is less than 5%. This is a painful condition that would require admission to hospital, but generally lasts a few days after the procedure. Rarely it can be more severe than this.  Please see my report card on my personal figures on ERCP.  Please click here to make an enquiry.