ERCP stands for endoscopic retrograde cholangio pancreatography. It can help to diagnose conditions of the liver, bile ducts, pancreas or gallbladder.
What is an ERCP?
Your doctor puts a tube called an endoscope down your throat to take x-rays of the pancreas, gallbladder and bile ducts. The endoscope is a long flexible tube with a small camera and light at the end.
The doctor can look down the endoscope or at pictures on a TV monitor. The test takes between 30 minutes and 2 hours.
Why you might have it
Having an ERCP helps your doctor find out what might be causing your symptoms. You might have this test to diagnose conditions of the:
- bile ducts
Your doctor can take samples (biopsies) of any abnormal looking areas.
You might have an ERCP as part of your treatment. For example, if your bile or pancreatic ducts are blocked your doctor can use it to put a plastic or metal tube (stent) into the duct to relieve the blockage.
Preparing for an ERCP
About 2 days before the ERCP you usually have a blood test to check how well your blood clots.
Let your doctor know if you are taking any medicines that change how your blood clots. These medicines include:
- arthritis medicines
- warfarin (Coumadin)
You might need to stop taking these medicines a number of days before the ERCP. Your doctor will give you advice about this.
You can't eat for about 6 to 8 hours before the test so that your stomach and small bowel (duodenum) are empty. You might be allowed to drink sips of water up to 2 hours before.
When you get to the x-ray department, the staff might ask you to change into a hospital gown. You lie on the bed or x-ray couch. The nurse might put a drip (intravenous infusion) into the back of one of your hands for antibiotics, to prevent infection. You might also have fluids through the drip.
You usually have an injection of sedation first to make you very drowsy. Your doctor might spray the back of your throat with local anaesthetic to make it easier to swallow the endoscopy tube.
What to expect
Once the sedative has worked, the doctor passes the endoscope tube down your throat to the area where the pancreas and bile ducts join the small bowel (duodenum). Your doctor will ask you to swallow as the tube goes down. You will be able to breathe normally.
Your nurse checks your pulse and oxygen levels throughout the test. You have oxygen through a tube that fits into your nose (nasal cannulae).
Your doctor can see the inside of your stomach and small bowel through the endoscope. They might put a small amount of air into the small bowel to help them see more clearly. They then inject dyes into the channels (ducts) in the biliary tree and pancreas so they can see them on x-rays.
Your doctor can take samples of cells from the bile ducts using a brush (brush cytology). And they may also take pieces of tissue (biopsies). They send these samples to the laboratory for examination under a microscope.
After the test
The doctor removes the tube. You rest for a while. You might need to stay in the department for a few hours.
You might not remember much (if anything) about the test once you have come round, if you have had a sedative.
You should be able to go home the same day. You will need to take someone with you to the hospital appointment. You won't be able to drive for the rest of the day and should have someone to go home with you and stay overnight.
ERCP is generally a safe procedure but as with any medical procedure, there are possible risks. Doctors make sure the benefits of the test outweigh these risks.
After the test you might have:
- a sore throat for a day or two
- bloating and discomfort in your tummy (abdomen) for a short time
- tenderness or a lump in your hand where you had the sedative injection
Possible problems after ERCP include:
- inflammation of the pancreas (pancreatitis)
- a hole (perforation) in the first part of the small bowel
Inflammation of the pancreas (pancreatitis) can happen in between 3 and 5 out of 100 people (3-5%), but the other problems are very uncommon. Your nurse will give you details of who to ring if you have any problems at home.
Contact the hospital where you had the ERCP or go the accident and emergency department (A&E) if you have:
- ongoing or severe pain in your abdomen
- a high temperature
- jaundice (yellowing of the skin), if you didn't have it before
- signs of bleeding
The amount of radiation you receive from the x-rays during the test is small and doesn't make you feel unwell.
The risk of the radiation causing any problems in the future is very small. The benefits of finding out what is wrong outweigh any risk there may be from radiation.
Talk to your doctor if you are worried about the possible effects of x-rays.
Getting your results
You should get your results within 1 or 2 weeks.
Waiting for test results can be a very worrying time. You might have contact details for a specialist nurse and you can contact them for information if you need to. It can help to talk to a close friend or relative about how you feel.
Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.
We have more information on tests, treatment and support if you have been diagnosed with cancer.