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ERCP

ERCP stands for endoscopic retrograde cholangio pancreatography. It can help to diagnose conditions of the liver, bile ducts, pancreas or gallbladder.

You have this test as an outpatient. It takes between 30 minutes and an hour.

Your doctor puts a tube into your mouth and down into the area between the stomach and small bowel to look at the pancreas.

Diagram of an endoscopic retrograde cholangio pancreatography

Preparing for an ERCP

Before the ERCP you usually have a blood test to check how well your blood clots.

Let the endoscopy department know if you're taking medicines to thin your blood such as warfarin. You might need to stop taking these medicines a number of days before the ERCP. Your doctor or nurse will tell you when you should stop.

You can't eat for 6 to 8 hours before the test. This is so that your stomach and duodenum are empty. You might be allowed to drink sips of water up to 2 hours before.

Because you have sedation for the test to make you drowsy, you will need someone with you to take you home and stay overnight. You shouldn’t drive, drink alcohol, operate heavy machinery or sign any legally binding documents for 24 hours.

It’s also a good idea to bring an overnight bag just in case you need to stay in hospital overnight.

What to expect

Once the sedative has worked, the doctor passes the endoscope tube gently 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 will check your pulse and oxygen levels throughout the test. You have oxygen through a tube that fits into your nose (nasal cannulae).

Through the endoscope, your doctor can see the inside of your stomach and small bowel. They may 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.

If there are any abnormal areas, the doctor will take pieces of tissue (biopsies) to send to the laboratory for examination under a microscope.

Detailed diagram of an endoscopic retrograde cholangic pancreatography (ERCP)

After the test

Your doctor removes the tube. You then need to 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 when you wake up from the sedation.

After the test you might:

  • have a sore throat for a few days
  • have bloating and discomfort in your tummy (abdomen) for a short time
  • feel sick or be sick after the sedation

Your nurse removes the cannula from your hand before you leave. You should be able to go home the same day. 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.

Getting your results

You should get the results within 1 or 2 weeks.

Usually the doctor who does the ERCP writes a report straight way. They send the report to your specialist, who gives the results to you. If your GP has sent you for the test, the results are sent directly to the GP surgery.

Waiting for results can be an anxious time. It might be helpful to talk to someone close to you. 

If it isn't an emergency and you haven't had your results a few weeks after your test, contact your doctor to chase your results for you.

Possible risks

ERCP is generally a safe procedure but as with any medical procedure, there are possible risks. Your doctor makes sure the benefits of the test outweigh these risks.

Inflammation of the pancreas (pancreatitis)

You may have pain in your tummy (abdomen) after this test. Your doctor can give you painkillers to help control this. It's important to tell your nurse or doctor if you get pain in your abdomen. 

Infection

There's a risk of infection with this test. If you get a temperature or generally feel unwell contact your doctor.  

Bleeding 

There may be some bleeding from having an ERCP which usually stops on its own. In some cases this can be severe and you will need medicine to stop it and maybe a blood transfusion. 

Allergic reaction

There is a risk of having an allergic reaction to the sedation or dye. This can cause problems with your breathing, heart rate and blood pressure. If this happens, the staff will give you medicines to control the reaction. 

Tear in your bowel

Very rarely there is a small tear (perforation) in the first part of your small bowel. If this happens it’s likely you would need surgery to repair the tear.

Exposure to radiation

The amount of radiation you receive from the x-rays during the test is small and doesn't make you feel unwell. Exposure to radiation during an x-ray can slightly increase your risk of developing cancer in the future. Talk to your doctor if this worries you.

When to contact a doctor

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
  • yellowing of the skin (jaundice), if you didn't have it before
  • black poo (this can be a sign of blood in your poo)
  • being sick and are unable to stop

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