Endoscopic retrograde cholangiopancreatography (ERCP)

Your consultant may recommend an ERCP if you have narrowed or blocked bile or pancreatic ducts due to trauma or disease. The procedure is normally used when your consultant expects to treat the condition during the same procedure. For your initial diagnosis, a less invasive procedure such as magnetic resonance cholangiopancreatography (MRCP) is normally used.

You may need an ERCP if you:

• Have signs of liver disease like jaundice (yellowing of the skin and the whites of the eyes), dark-coloured urine, clay-coloured stools, or itchy skin
• Have abnormal liver function tests
• Have had a CT or ultrasound scan that shows a blockage, stones, or a mass in your bile or pancreatic ducts

ERCP may be used to treat blocked or narrowed bile or pancreatic ducts. Blockages can be caused by stones, narrowing of the bile ducts or cancers or growths in the bile and pancreatic ducts.

A small mesh tube called a stent may be inserted into a collapsed duct to hold it open. ERCP can also be used to take a sample of tissue (biopsy) from a mass in the bile or pancreatic duct.

Conditions ERCP can be used to treat include:

• Acute or chronic pancreatitis
• Cholecystitis (inflammation of the gallbladder)
• Gallstones
• Infection
• Trauma or injury to the bile or pancreatic ducts
• Pancreatic pseudocysts
• Pancreatic tumours
• Bile duct tumours

At your first consultation, you will be seen by a consultant gastroenterologist, a doctor specialising in conditions affecting the digestive system.

Your consultant will ask you about your symptoms, general health, and medical history. They will perform a physical examination and may ask to see the results of any previous tests or scans or arrange for them on the day. These may include an ultrasound and tests to check you are fit for surgery such as blood tests, electrocardiogram (ECG) and a chest X-ray.

At Circle Health Group, your first appointment is important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have about your procedure.

At the end of your appointment, your consultant will decide if an ERCP is suitable for you based on your diagnosis, general health and the results of your tests and scans. They will explain the procedure fully including how to prepare for your ERCP, what happens during the procedure, any possible risks, and complications, and what to expect during your recovery. We want you to be as well-informed and comfortable as possible before, during, and after your ERCP, so please ask your consultant any questions you may have.

Your consultant will tell you everything you need to do to prepare for your ERCP. If there's anything you're not sure about, or if you have any questions, speak to your consultant or call the hospital for advice.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication, including over-the-counter medicines you are taking. Tell your consultant if you are allergic to shellfish or iodine or have had a previous adverse reaction to any contrast dyes.

Tell your consultant if you are pregnant. Your ERCP may be postponed until after delivery unless it is considered urgent.

You will need to sign a consent form before your ERCP. Make sure you understand what is involved in the procedure, including any possible risks and complications, and expected recovery time. Please ask your consultant if you have any questions or concerns about your surgery.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything for six to eight hours before your ERCP. You may be able to have sips of water for up to two hours before. Check with your consultant when you need to stop eating and drinking before your surgery.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

ERCP is normally carried out under heavy sedation which means you'll be awake but will feel very relaxed and sleepy during your procedure. You will be given a local anaesthetic in the form of a throat spray or gargle to numb your throat and stop you from gagging during the procedure.

In some cases, you may be given a general anaesthetic for your ERCP. Your consultant will discuss the type of anaesthetic you'll receive before your surgery.

During your ERCP, you will lie on the examination table, normally on your left side. A plastic mouthguard will be placed in your mouth for the endoscope to pass through. You will be given oxygen through soft plastic tubes in your nostrils.

Once your sedation has taken effect, your consultant will pass a thin flexible tube with a camera called an endoscope down your throat into your stomach and duodenum. The endoscope will pump gas into your stomach and duodenum to make it easier for your consultant to see what's going on inside. The camera will transmit images to a monitor for your consultant to examine.

Your consultant will locate the opening where the common bile duct and pancreatic duct join with the duodenum. A thin, flexible tube is passed into the opening and a dye called contrast medium is injected.

A special type of X-ray called fluoroscopy is used to take pictures of your ducts and check for narrowing or blockages.

Your consultant may use small, specially designed instruments to:

• Open blocked or narrowed ducts
• Insert a stent to hold open collapsed ducts
• Take biopsies
• Remove tumours
• Break up or remove stones

ERCP normally takes between 30 minutes and two hours depending on what is done during your procedure.

After your ERCP, you will need to stay in the department for around six hours. This is to allow you to rest and for the effects of the sedation to wear off completely.

You may feel sick (nauseous) after your procedure. This is due to the sedation you received and normally resolves within a few hours.

You may have a slightly sore throat and feel bloated from the gas that was pumped into your abdomen for a day or two after your ERCP. It may help to stick to a soft diet for a few days until your throat is better.

The nursing staff will let you know when you can eat and drink after your procedure.

You will need to arrange for someone to collect you from the hospital and stay with you for the first night after your surgery. You should rest at home for the rest of the day after your ERCP.

How many nights will I need to stay in hospital?

ERCP is normally performed as an outpatient which means you'll be able to go home a few hours after your procedure. In some cases, you may need to spend one night in hospital.

Will I be able to drive home?

Due to the sedation you were given during the procedure, you will not be able to drive yourself home from the hospital after your ERCP, or for at least twenty-four hours afterwards. Please make arrangements for someone to come and collect you and stay with you for the first night after your surgery.

How soon can I go back to work?

When you can go back to work depends on what was done during your procedure and the type of job you do. Most people can return to work the following day after ERCP. Check with your consultant when you can go back to work after your surgery.

How soon can I drive?

You can normally drive twenty-four hours after ERCP.

When will I be back to normal?

Most people are fully recovered and able to resume normal activities around twenty-four hours after ERCP.

ERCP is a generally safe procedure, however, like all types of surgery, there is a small risk of complications. Your consultant will explain all the possible risks and complications before your procedure and answer any questions you may have to allow you to make an informed decision.

Possible complications of ERCP include:

• Nausea due to the sedation used during the procedure
• Bloating due to the air pumped into the stomach during the procedure
• Infection of the bile ducts or gallbladder
• Bleeding
• Perforation (tears) of the bile or pancreatic ducts
• Inflammation of the pancreas (pancreatitis)
• Aspiration pneumonia
• Adverse reaction to the sedation or dye

The most common complication of ERCP is inflammation of the pancreas (pancreatitis). This may occur when the pancreatic duct becomes irritated by the contrast dye or the tube. Around 5% of patients undergoing ERCP will develop mild pancreatitis.

Call your healthcare provider immediately if you experience:

• Severe abdominal pain
• Chest pain
• Difficulty breathing
• Difficulty swallowing
• Fever (a temperature of above 38C)
• Vomiting
• Bloody, black, or tar-coloured stools

Diagnostic imaging scans

Your consultant may start with a non-invasive test or scan to check for abnormalities in your bile and pancreatic ducts. These may include MRI, CT, or ultrasound scans. While these can be useful for diagnosing problems, they cannot be used for interventions such as taking biopsies, putting in stents, or removing stones.

SpyGlass ERCP

This is a procedure where a thin tube called a SpyGlass (cholangioscope) is attached to the standard endoscope and passed into your bile ducts to allow your consultant to examine them more thoroughly. SpyGlass ERCP can also be used to break up bile or pancreatic stones and take biopsies. SpyGlass ERCP may be done after standard ERCP if your consultant needs more detailed information. The procedure takes longer than a standard ERCP and has a higher risk of complications. It is normally carried out under general anaesthetic.

Percutaneous transhepatic cholangiogram (PTC)

During this procedure, a long, flexible needle is inserted into your liver and a contrast dye is injected. X-rays are used to take pictures of your bile ducts. PTC has a higher risk of side effects than ERCP. It is normally performed under sedation but may be done under general anaesthetic.

We answer some of your most commonly asked questions about ERCP.

How long after ERCP can pancreatitis develop?

Pancreatitis is most likely to develop in the first six hours after ERCP. The risk is much less after the first twelve to twenty-four hours.

Is ERCP a type of surgery?

ERCP is a diagnostic procedure that can also be used to treat problems surgically. During your ERCP, your surgeon may use specially adapted instruments to perform surgery. This may include the removal or breaking up of stones, stent insertion or taking biopsies.

Does ERCP hurt?

During your ERCP you will be given sedation and local anaesthetic and should not feel any pain. Some people experience mild discomfort and bloating as air is pumped into the bile and pancreatic ducts. After your ERCP you may have a sore throat due to the tube being passed down your oesophagus during the procedure. Over-the-counter painkillers like paracetamol and ibuprofen can help with this, and it normally resolves after a day or two.

Does ERCP require anaesthesia?

ERCP is normally performed under sedation and local anaesthetic. In some cases, your consultant may want to give you a general anaesthetic before your ERCP, but they will discuss this with you before the procedure.

How long does ERCP take?

Depending on what is done during the procedure, ERCP normally takes between thirty minutes and two hours.

How soon can you eat after ERCP?

You will be given clear fluids in the department when your sedation has worn off and you can swallow properly. The nursing staff will advise you when you can eat and drink after your ERCP. You may be advised to follow a low-fat diet for up to a week after your procedure. This is to reduce the risk of digestive problems. Talk to your consultant about what you can eat and drink after your ERCP.

Is ERCP safe?

ERCP is a generally safe procedure, but like any surgery, it carries a small risk of complications. Your consultant will explain all the possible risks and complications of ERCP before your procedure and ensure that you are able to make an informed decision.

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about ERCP, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Endoscopic Retrograde Cholangiopancreatography (ERCP), NIH: National Institute of Diabetes and Digestive and Kidney Diseases
2. Overview: ERCP (endoscopic retrograde cholangiopancreatography), Guy’s and St Thomas’ NHS Foundation Trust
3. ERCP test, Cancer Research UK
4. Endoscopic Retrograde Cholangiopancreatography (ERCP), Cleveland Clinic