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ERCP -  Endoscopic Retrograde Cholangio Pancreatography

(Examination of Pancreas, Bile Ducts, Liver and Gallbladder)

ERCP is a valuable tool for the diagnosis of many disorders of the pancreas, bile ducts, liver and gallbladder. ERCP is a highly sophisticated technique, requiring special endoscopic training, and can be accomplished successfully in a high percentage of patients.For the procedure, a flexible rubber-like tube called an endoscope, is passed through the mouth, esophagus (food tube), stomach and into the duodenum (the first point of the small intestine). A small plastic tube (catheter) is passed through a tiny opening that leads to the pancreatic and common bile duct. Radio-opaque dye is injected through the catheter and x-rays are taken in order to study the ducts. The procedure usually takes 30 to 60 minutes.

                     Preparation for the Procedure

Preparation for the test varies as to what time of the day you will be having the examination.If you are scheduled in the morning, do not eat or drink anything including antacids after midnight. Please check with your physician concerning any medication you are presently taking.If your are scheduled in the afternoon, you may have clear liquid breakfast at 7 a.m., then nothing to eat or drink including antacids until after the examination. Please check with your physician concerning any medication you are presently taking.

A clear liquid diet contains no milk; it does include jello, clear broth, tea or coffee with sugar, strained fruit juice, carbonated beverages, and plain sugar candy. Please have a friend or relative drive you for the test as medication may be given for sedation and you will not be able to drive for 12 hours. Friends or relatives may wait in the waiting room. Please leave jewelry and other valuables at home or with a relative of friend.You will be asked to sign a consent from authorizing the procedure. Please wear comfortable, loose clothing. You will be able to change into a hospital gown. Please empty your bladder before the nurse takes you to the examination room Your blood pressure and pulse will be recorded. An intravenous solution (I.V.) will be started in your arm. It will be used during the procedure to give medication.If you have not already done so, you will have an opportunity to discuss this procedure with your physician or nurse.

You will be asked if you are allergic to any medication. Please inform the nurse if there is a possibility of pregnancy (if applicable) as an x-ray will be used. You will also be asked to remove dentures and/or glasses, if applicable.

During The Procedure

You will be given a local anesthetic to numb your throat, mouth and tongue. The room will be darkened and you will lie on your left side for the procedure.


An intravenous medication (I.V.) will be given to help you relax and become drowsy. When you are properly relaxed, the endoscope will be passed. This is ordinarily accomplished with surprising ease, due to the relaxing effect of the sedation. The tube does not interfere with your breathing. Secretions will be sanctioned out of your mouth throughout the procedure.As x-rays are taken you will be asked to hold your breath.You may be asked to turn from side to side or on your stomach during the examination. You will be assisted by the nurse.

After the Procedure

As soon as the endoscope is removed, your blood pressure and pulse will be recorded. The only discomfort following the examination is generally limited to a mild sore throat and/or a need to "burp" the air which has been put in the stomach during the examination.

You will be moved to the recovery room where your vital signs will be monitored. Your physician will then discuss results of the procedure with you and your family.

If you are an inpatient you will be taken back to your room.

Because of the after-effects of the medication you are advised

  • Not to return to work
  • Not to operate any machinery (including kitchen equipment)
  • Not to drink any alcohol for at least 12 hours following the test

Contact your physician immediately if you develop any of the following

  • Severe pain
  • Black tarry stools
  • Vomiting and Temperature over 100* F

If you develop a sore throat, gargle with warm salt water or use throat lozenges from your local drugstore. You may develop a lump and/or redness at the site where your I.V. sedation was given. Apply a warm compress (a cloth soaked in warm water may be used) to the area to reduce discomfort. When you return home you may resume your regular diet unless directed otherwise.If you have any questions about the examination, please feel free to discuss them with your physician or one of the nurses.


Depending on the findings of your ERCP, another procedure might be indicated.

They could include :

  • Papillotomy (Sphincterotomy)
  • Sphincter of Oddi Manometry
  • Nasal Biliary Catheter Placement (NBC)
  • Stent Placement
  • Common Bile Duct (CBD) Dilation
  • Pancreatic Duct (PD) Dilation


The use of a cutting wire and electric current to incise the Sphincter of Oddi, a band of muscles surrounding the opening of the ducts that drain the gall bladder, liver and pancreatic duct.

Sphincter of Oddi Manometry

Pressure tracings measuring the muscle activity of the Sphincter of Oddi. A band of muscles surrounding the opening of the ducts that drain the gall bladder, live and pancreatic duct.

Side Effect & Risks

ERCP is safe and is associated with very low risk when performed by physicians who have been specially trained and are experienced in this highly specialized procedure. Complications can occur but are uncommon.One possible complication is pancreatitis due to irritation of the pancreatic ducts by the x-ray contrast material. Another possible complication is infection.Localized irritation of the vein may occur at the site of medication injection. A tender lump develops which may remain for several weeks to several months, but goes away eventually.Other less common risks include perforation (tear) of the bowel, drug reactions, and complications from unrelated diseases such as heart attack or stroke.Death is extremely rare, but remains a remote possibility.If your procedure is being done at one of the above hospitals, please call to pre-register one to two days prior to your procedure. Pre-registration of your insurance information will avoid delays the day of your procedure. The telephone number is listed with the designated hospital.