ERCP Procedure to Diagnose and Treat Digestive Conditions
Medically reviewed by Jay N. Yepuri, MD, MS
Endoscopic retrograde cholangiopancreatography (ERCP) is a type of endoscopy that may be used to both diagnose and treat problems in the bile and pancreatic ducts. It is usually performed by a skilled gastroenterologist (specialist in digestive system disorders).
ERCP involves inserting a flexible tube (endoscope) with a light and a camera on the end into the mouth and down into the throat, stomach, and first part of the small intestine. An ERCP might be done for symptoms of abdominal pain or jaundice (yellowing skin and eyes) or for already diagnosed conditions such as cancer in the liver, pancreas, or bile ducts.
This article will cover the ERCP procedure, why it might be used, the steps of the procedure, recovery, and what results may indicate.
ERCP: A Test or Surgery?
An ERCP can be used to make a diagnosis, perform a procedure, and deliver treatment. It is minimally invasive as it doesn't involve an external incision, as opposed to open surgical procedures.
If there is a suspected problem in the bile ducts or the pancreatic ducts, an ERCP might be used to diagnose the source of the symptoms. The benefit of this procedure is that it may be used to diagnose the condition and treat it in some cases.
Some of the conditions that might prompt a healthcare provider to decide to order an ERCP include the following:
Acute or chronic pancreatitis (inflammation of the pancreas)
Conditions of the bile ducts (such as primary biliary cholangitis or sclerosing cholangitis)
Gallstones in the common bile duct
Infection
Physical trauma to the bile ducts or pancreas
Complications after surgery in the bile ducts or ducts of the pancreas
Pseudocysts (a fluid-filled sac of leaked pancreatic fluids near the pancreas)
With an ERCP, once the source of the symptoms is understood, a procedure might be used to treat it. Some of the procedures that might be done during an ERCP include:
Draining fluid from ducts
Removing gallstones, either by crushing them or extracting them
Taking a biopsy (sample of tissue) from the pancreas, bile ducts, or gallbladder
Widening the opening between the pancreatic ducts and the bowel (sphincterotomy)
Widening strictures (narrowed areas) in the bile ducts
How an ERCP Procedure Helps With a Diagnosis
An ERCP is a useful procedure, but it is invasive. Noninvasive tests might also be used prior to an ERCP to get a better idea of the potential diagnosis.
However, an ERCP can be used to actually see inside the structures of the body. This can help confirm a diagnosis. It can also be used to take a biopsy (small piece of tissue) that can be tested for cancer, inflammation, or other abnormalities.
Meaning of ERCP Procedure Results
An ERCP may provide some results immediately because the healthcare provider may be able to see what is happening.
You might meet with your healthcare provider after the procedure to learn how the procedure went. This is also the time that a healthcare provider will explain any procedures that were used during the ERCP and about any aftercare.
The results of biopsies will take longer, usually a few days. A pathologist will examine the biopsies microscopically to understand more about what is happening with the tissue. The healthcare provider who ordered the ERCP will usually be the one to deliver those results and what they mean for the future.
Step-by-Step ERCP Procedure Walk-Through
An ERCP is a test done by a healthcare provider (usually a gastroenterologist) specially trained in the procedure. It might be done at an outpatient endoscopy center or a hospital.
The procedure could take a few hours. Instructions will be given about timing and any need for prep. After receiving sedation, you will need someone to drive you home if you are discharged. Sometimes a stay in the hospital will be needed.
Procedure
After arriving for the test, you will be asked to remove any jewelry and change into a hospital gown.
This test is done while you are sedated. An intravenous line (IV) will be started, and medicine that helps with relaxation is given through it. In some cases, general anesthetic may be used (you will be asleep through the procedure).
A local anesthetic, either a gargle or a spray, is also used to numb the throat. The anesthetic is strong enough that swallowing may not be possible, so saliva will be suctioned out of your mouth.
You will be brought into the treatment room and will lie on a table, either on your stomach or left side. Monitoring equipment will be used to watch your vital signs, such as heart rate and breathing. Teeth will be protected with the use of a mouth guard.
The endoscope is gently inserted into the mouth, down through the esophagus, into the stomach, and then into the first part of the small intestine (the duodenum).
The endoscope has a camera on the end, which will send the image to a video screen. Air will be put through the endoscope and into the body, which will help the healthcare provider see better.
Contrast dye will also be used. This dye is inserted in the ducts so that when X-rays are taken, they are easier to see on the film. Sometimes, you may be asked to change positions for the X-rays.
If there is a need to use a treatment, the endoscope will also be used for that. Tools are passed through the endoscope. These tools can be used to deliver a variety of treatments. This can include:
Inserting tubes (stents) to hold open bile ducts that are too narrow
Opening up ducts that are narrowed
Removing or breaking up stones in the ducts
Removing tumors
Taking small pieces of tissue (biopsies)
Aftercare
You will be cleared to go home when you are stable after the procedure. It’s also important that the local anesthetic has worn off and you are able to eat and drink.
In some cases, you may need to stay overnight in the hospital for observation. Pain medications may be given because some people may experience pain after the procedure. It’s important to talk about pain management with healthcare providers before the procedure.
Instructions will be given on how to manage activity and diet over the next few days. Rest will be advised for the remainder of the day after the procedure. You may need a few days to get back to a regular diet and activity level.
Some of the things you may experience after an ERCP could include nausea, a sore throat, dark stools, or stools streaked with some blood. These symptoms should improve in the hours after the procedure.
There is the potential for complications after an ERCP. Some of the warning signs to watch for include:
Blood in the stool
Fevers
Hemoptysis (coughing up blood)
Hematemesis (vomiting blood)
Jaundice (yellowing of the skin and whites of the eyes)
Recurrent vomiting
Severe abdominal pain
Complications
There is the potential for complications with an ERCP. One study showed that the risk of developing a hole (perforation) in the upper digestive system was 1%. A perforation is a serious complication that may be fatal. The overall risk of death with the procedure in one study was shown to be less than 1%.
It is important to pay attention to any symptoms that occur after the test, such as abdominal pain, and to get care right away if there are any concerns.
Overcoming Fear and Anxiety About ERCP Procedure
It’s natural to feel anxiety or worry before an ERCP. People who are having this procedure may also already be coping with other health issues and troublesome signs or symptoms.
Talking these concerns over with a healthcare provider can be helpful. This can include getting more information about particular concerns, such as sedation or the potential for complications. There are usually solutions available when a provider knows what the barriers are.
Some people are concerned about their gag reflex during the procedure. The sedation that’s given before the procedure will help reduce the gag reflex.
It might also help to discuss ERCP with others who've gone through it. Ask your healthcare provider if they can direct you to another patient or a support group to meet with.
Many healthcare practices and hospitals also can offer the help of a counselor, social worker, or psychologist. Working with a provider who has experience with people who are having anxiety before a procedure can be helpful in addressing difficulty.
Summary
An ERCP is a procedure that is helpful for several diseases and conditions of the bile and pancreatic ducts. It is invasive, but skilled healthcare providers will help in making the procedure as comfortable as possible.
Some results will be available right away after the procedure, but others may not be available for a few days. Working with healthcare providers and communicating about all aspects of the test will help in having the best outcome.
