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ERCP stands for Endoscopic Retrograde Cholangio Pancreatography

Uses an endoscope which is a long narrow tube with a camera at the end. The doctor passes the endoscope through your mouth (under sedation/anesthesia) to get into the papilla of Vater, a small nipple in your upper intestine (duodenum). This papilla is the drainage hole for your bile duct and the pancreatic duct, which bring digestive juices from your liver, gallbladder and pancreas. X-rays are taken to show whether there are any lesions such as stones, spasms or blockages. If the x-ray pictures do show a problem, the doctor may be able to treat it right away. The most common treatments are:

  • Sphincterotomy: This involves making a small cut in the papilla of Vater to enlarge the opening to the bile duct and/or pancreatic duct. This is done to improve the drainage or remove stones in the ducts. Removed stones are usually dropped in the intestine, and pass through quickly.
  • Stenting: A stent is a small plastic tube which is left in a blocked or narrowed duct to improve drainage. The narrowing may need to be stretched (dilated) before the stent is placed. Some stents are designed to pass out into the intestine after a few weeks when they have done their work. Other stents have to be removed or changed after 3-4 months. There are also permanent stents made out of metal.
  • Other treatments are used occasionally. Your doctor will explain these if necessary.

Limitations and Risks. There are some drawbacks to ERCP. Discuss these with your doctor.

  • The test and treatments are not perfect. Occasionally, important lesions may not be seen, and treatment attempts may be unsuccessful.
  • The medicines may make you sick. You may have nausea, vomiting, hives, dry mouth, or a reddened face and neck. A tender lump may form where the IV was placed. Call your doctor if redness, pain or swelling appears to be spreading.
  • You will receive a low dose of radiation from the x-rays.
  • Working on the pancreas can cause complications, even in the best hands. Your doctor will explain these and answer your questions. The most common complication is pancreatitis.
    Pancreatitis (swelling and inflammation of the pancreas), This occurs in about one patient in twenty and results in the need to stay in the hospital for pain medications and IV fluids. This usually lasts for one or two days, but can be much more serious.

Other rare complications (less than 1 per 100) include, but are not limited to:

  • Bleeding (after sphincterotomy).
  • Heart and lung problems.
  • Infection in the bile duct (cholangitis).
  • Perforation (a tear in the intestine).
These may require surgery (about one case in 500), and prolonged stays in the hospital. Fatal complications are very rare.

Alternatives. There are some different approaches. Discuss them with your doctor.

  • Diagnoses can be made often by scans, such as Ultrasound, CT, MRI or nuclear medicine scans. ERCP is usually done only when appropriate scans have failed to provide a diagnosis, or when they have shown something that is best treated by ERCP.
  • Alternative treatments include surgical operations, or in some cases, interventional radiology.
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