Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas.

The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces substances that help with digestion and hormones such as insulin.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

ERCP Diagram

ERCP combines the use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.

For the procedure, you will be sedated and placed on an examining table in an x-ray room. The physician will insert a scope into your mouth and then guide it through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum.

The physician will pass a small plastic catheter through the scope and into the bile duct and pancreatic duct. Dye will be injected into the ducts and x-rays will be taken. If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove the gallstone or open the narrowing. If needed, biopsies can be obtained.

ERCP is generally a safe procedure. However, there are occasionally complications. Rarely there can be bleeding, perforation (poking a hole in the bile duct), over sedation, and allergic reaction to medications. Pancreatitis (inflammation of the pancreas) can occur as well in about five percent of cases and can result in post-operative abdominal pain, nausea, vomiting, and need for hospitalization. It usually resolves in 3-5 days, but rarely can be severe and require prolonged hospitalization.

Make sure to discuss the risks and benefits of ERCP with your physician prior to undergoing the procedure.