ERCP test

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

What is an ERCP?

Your doctor uses a long flexible tube with a small camera and light at the end, called an endoscope. It's also sometimes called a duodenoscope. They pass this tube through your mouth, throat, stomach and into the first part of your small bowel (duodenum).

Your doctor can look down the endoscope or see pictures on an X-ray screen of the pancreas , gallbladder and bile ducts .  

They can take biopsies of any abnormal looking areas. 

You usually have an ERCP in the endoscopy department. The test takes between 30 minutes and 2 hours.

Why might you have an ERCP?

Having an ERCP helps your doctor find out what might be causing your symptoms. You might have this test:

• if your blood tests show abnormal liver results
• if you have severe inflammation of the pancreas (pancreatitis)
• to help work out how big a tumour is (the stage)
• if your doctor thinks there is a blockage in your bile ducts – this causes symptoms including yellowing of your skin and whites of your eyes, itchiness, tummy pain and dark coloured urine 

You might have an ERCP as part of your treatment. For example, if your bile or pancreatic ducts are blocked. Your doctor can use the ERCP to put a plastic or metal tube (stent) into the duct to relieve the blockage.

Preparing for an ERCP

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

Let the endoscopy staff know if you're taking medicine that changes how your blood clots. This includes:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban

You might need to stop taking this type of medicine a number of days before the ERCP. Your doctor or nurse will tell you when you should stop. They will also tell you if you need to stop taking any other medicines and when to 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 able to drink sips of water up to 2 hours before your appointment. You will have written instructions from the endoscopy staff about this beforehand. It is important to read it carefully, as some hospitals may have different instructions. Call the number on the letter to speak to the endoscopy staff if you have any questions.

Talk to your doctor or nurse if not eating could be a problem for you. For example, if you have diabetes.

Because you have sedation  for this test, 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.

How you have an ERCP

You usually have this test in the endoscopy department, but you might have it in the x-ray department. Your appointment letter will tell you where to go.

Before the procedure you see the doctor. They explain the procedure to you and ask you to sign a consent form. This is a good time to ask any questions you may have. 

You usually change into a hospital gown and remove any jewellery or metal objects on your body. As this will interfere with the x-ray pictures they take.  

You lie on the bed or x-ray couch. The nurse puts a small plastic tube (cannula) into the back of one of your hands.

Your nurse gives you a plastic mouth guard to wear. This is to protect your teeth and gums during the test. They also give you oxygen through a tube that fits into your nose (nasal cannula).

During the test

You usually have an injection of sedation first to make you very drowsy. Your doctor might spray the back of your throat with a local anaesthetic to numb the area and make it easier to swallow the endoscopy tube.

Once the sedative has worked, your doctor passes the endoscope. They pass the tube through your mouth, down your throat into your stomach. They'll ask you to swallow as the tube goes down. You will be able to breathe normally, but you may gag slightly.

Once in the stomach, it then goes into your duodenum. This is where the pancreatic and bile ducts join. They might put a small amount of air into your stomach to help them see more clearly. This can make some people feel uncomfortable and like they want to burp.

They pass a thinner tube down through the endoscope which can fit into your bile duct. They then inject dye (contrast medium) through the tubes into the channels (ducts) of the biliary tree and pancreas. This is so they can see them on x-ray pictures.

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. They may also take some photographs.

Your nurse checks your heart rate, breathing rate and oxygen levels throughout the test.

Cholangioscopy

You might also have a cholangioscopy when you have an ERCP.  This gives clearer views of the bile ducts. During the ERCP your doctor puts a smaller tube called a cholangioscope down through the endoscope. This smaller tube has a probe and camera attached. The cholangioscope can go directly into the bile ducts. Your doctor can see if there are any abnormal areas and take biopsies.

The test takes longer if you have a cholangioscopy and you usually have a general anaesthetic .

A cholangioscopy is also called a SpyGlass procedure.

Your doctor and specialist nurse will give you more information if you need to have this test. 

After the test

Your doctor removes the tube. You then need to rest for a while. You stay in the department for a few hours after this test. The nursing team will look after you until you are ready to go home. They will give you pain relief medication if you have any pain or discomfort. They will also let you know when you can start to eat and drink. 

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 day or two
• 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.

If your doctor needs to monitor you for longer after the test, you may need to stay in hospital overnight. 

Possible risks

There are possible risks with an ERCP. Some can be serious and life threatening. Your doctor makes sure the benefits of the test outweigh these risks. Your doctor or nurse will explain all the risks of having an ERCP and what to look out for. And they will tell you who to contact if you have any problems after your test.

Some of the possible risks include:

Inflammation of the pancreas (pancreatitis)

You may have inflammation of the pancreas after this test. This can cause pain in your tummy (abdomen). 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. 

Inflammation of the pancreas can also be severe. You might need to stay in hospital for some days if this happens.

An infection

There's a risk of infection with this test. Contact your hospital advice line or doctor straight away if you have a high temperature, feel feverish or shivery, or generally feel unwell. 

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 . 

An 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. Tell the staff immediately if you feel unwell.

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.

Damage to your teeth

There is a small risk that your teeth or crowns may be damaged during this test, but this is not very common.

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. Talk to your doctor if this worries you.

When to contact a doctor

Contact the hospital advice line where you had the ERCP or go to the accident and emergency department (A&E) if you have:

• ongoing or severe pain in your tummy
• 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

Getting your results

You should get your results within 1 or 2 weeks at a follow up appointment, but it may take longer. Contact the doctor who arranged the test if you haven’t heard anything after a couple of weeks.

Waiting for test results can be a very worrying time. You might have contact details for a specialist nurse. You can get in touch with them for information and support if you need to. It may help to talk to a close friend or relative about how you feel.

More information

We have more information on tests, treatment and support if you have been diagnosed with cancer.