What is ERCP (Endoscopic Retrograde Cholangio-Pancreatography) and why is it done?

ERCP is a procedure used to diagnose and treat diseases of the bile ducts and pancreas. Depending on the difficulty of the procedure, ERCP can last from half to two hours and is performed under radiological control.

Due to the minimally invasive method of ERCP, the patient can avoid difficult surgery that require many days of hospitalization and have high rate of complications.

It is done using a special tube called a duedenoscope, which enters through the mouth into the esophagus, stomach and then the duodenum.

The most common indications for performing an ERCP are:

  • The diagnosis and removal of stones from the bile duct (choledocholithiasis).
  • Finding the cause and treating jaundice. In this case a small tube (stent) can be placed so that the bile drains into the small intestine.
  • Treatment for complications of surgery, such as bile leakage after cholecystectomy.
  • Tumors of the pancreas – bile ducts.

With ERCP the invasive gastroenterologist can clean the bile duct from stones, which are removed by special catheters. The patient is thus relieved of the risk of a possible cholangitis or acute pancreatitis, conditions that have a high morbidity and may be life-threatening.

In cases of bile obstruction due to stenosis or tumors of the bile ducts or pancreas, a plastic or metal stent may be placed. Thus, the normal flow of the bile is restored and the patient is relieved of jaundice. In case of bile leakage after cholecystectomy, a plastic stent can be placed which “bridges” the point of escape and thus prevents the bile from flowing into the abdomen.

To have an ERCP performed you need to be admitted to a Hospital with appropriate infrastructure for the procedure. In order to have the examination performed, the patient must stop any anticoagulant treatment (Warfarin, Xarelto, Eliquis, heparin, clopidogrel – Plavix, etc.) that he/she receives and replace it with subcutaneous heparin injections. This will always be done in consultation with the treating cardiologist.

It is forbidden to take any food at least 12 hours before the procedure and you should avoid taking fluids on the day of the examination.

If you are pregnant please let us know.

ERCP must always be performed by qualified personnel.

Arriving at the radiology department the nurse will take you to the examination preparation area and will ask you to sign the consent form for the procedure. Then you will wear a robe, and you will also need to remove dentures as well as eyeglasses which will be kept safe by unit staff until the end of the examination.

You will be asked to lie on your stomach on the bed of the X-ray department. Before the examination, a venous catheter will be placed in your arm and sedative and analgesic drugs will be administered by the anaesthetist.

The special flexible endoscope is then advanced from the mouth to the ampulla of Vater located in the duodenum. There the doctor will pass through the endoscope some thin catheters into the biliary or the pancreatic duct. With the help of these catheters, contrast is injected and the bile duct or the pancreatic duct is imaged on X-ray. If necessary, an incision can be made in the Vater’s sphincter (sphincterotomy), so that it is possible to remove stones with the help of a balloon or to place a stent. During the procedure, if a tumor is found in the bile ducts, it is possible to take cells for histopathological examination.

The doctor will inform the relative or nurse accompanying you about the results of the ERCP and will give a written report.

In the afternoon of the same day, it is allowed to take fluids 3 hours after the operation unless the doctor gives other instructions.

There is a small percentage (up to 10%) of failed ERCP for various reasons.

If complications occur, they are usually mild. Serious complications are rare.

ERCP is less risky than surgical alternatives for biliary and pancreatic disease. As with any procedure, there are possible complications but incidence rates are low. The most common complications that may occur are the following:

• Pancreatitis (occurs in 3-5%). It is an inflammation of the pancreas and is usually mild. It manifests itself with abdominal pain and vomiting a few hours later and is confirmed by blood tests. In most cases the patient recovers completely in a few days. In some cases pancreatitis can be severe and the patient should be kept in hospital.
• Bleeding (occurs in 1-2%). It can occur after a sphincterotomy and usually stops on its own
• Perforation of the duodenum. It is a very rare complication and can occur either during sphincterotomy or less frequently by the endoscope. Surgery may be needed to treat it
• Bile duct infection (cholangitis). It is usually treated with intravenous antibiotics.

Although complications are rare during or after ERCP, contact us in case of unusually severe abdominal or chest pain, difficulty in breathing, fever or black stools.