Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that can help diagnose and treat pancreatic or bile duct blockages.

An ERCP combines the benefits of gastrointestinal (GI) endoscopy and X-rays.

Developed in the late 1960s, doctors once primarily used the procedure to diagnose duct disorders. Nowadays, doctors use the ERCP procedure to both diagnose and treat these health issues.

Read on for more about ERCP, including how it works, recovery time, effectiveness, and possible complications.

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The ERCP procedure diagnoses and treats narrowed or blocked pancreatic or bile ducts. It combines endoscopy and fluoroscopy.

In a GI endoscopic procedure, a doctor inserts a long, thin, hollow tube called an endoscope down a person’s throat and into their duodenum, or small intestine. The endoscope has a light and a viewing lens.

Once the doctor positions the hollow endoscope correctly, they pass another long narrow tube called a catheter into the endoscope. They use the catheter to deliver dye to the affected area to develop X-ray images.

With fluoroscopy, doctors get a continuous flow of X-ray images which helps them:

  • guide catheters through a person’s ducts
  • assess the condition of a person’s bile and pancreatic ducts, and gallbladder
  • remove stones and other blockages
  • place devices called stents in ducts to keep them open

Doctors use ERCP for both diagnosis and treatment. They may use it to observe the drainage ducts from the liver and the pancreas, also known as the bile or pancreatic ducts. It can also help doctors examine the gallbladder.

Treatments doctors may conduct during an ERCP procedure include:

  • making a small incision called a sphincterotomy, which enlarges the openings of the ducts
  • removing stones from the bile duct
  • placing stents in the bile or pancreatic ducts
  • using balloons to stretch out narrowed passages in the ducts
  • collecting a tissue sample to search for signs of cancer

An ERCP procedure can also help doctors determine if a person needs surgery.

According to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the reasons for conducting an ERCP procedure include:

  • abnormal ultrasound, CT scans, or blood tests
  • stones in the pancreatic or bile ducts
  • pre- or post-gallbladder surgery concerns
  • a blocked bile duct

The ERCP procedure takes roughly 30–60 minutes. It involves the following steps:

  • numbing the throat to prevent gagging and promote comfort
  • intravenous sedative administration for relaxation or total anesthesia
  • using air to inflate the duodenum
  • inserting the endoscope into the duodenum
  • inserting the catheter through the endoscope
  • injecting dye for the X-rays through the catheter
  • studying the X-ray images to analyze the condition of a person’s ducts, collect a tissue sample for a biopsy, remove stones, or place a stent, depending on a person’s condition

The recovery period after an ERCP procedure is typically short. A person rests in the outpatient facility or clinic until the sedatives wear off, which usually takes 1–2 hours. They should not drive themselves home.

A person can eat their regular diet after the procedure, but doctors recommend relaxing for the rest of the day. Some people may have a sore throat for a few days. Some people may also need to stay in the hospital overnight after an ERCP procedure.

Research shows that the ERCP procedure is generally effective and safe for people of all ages.

A relatively small 2021 study of 126 people in their 90s found that the ERCP procedure was effective. Additionally, these older participants did not have more complications than people between the ages of 65 and 89.

A study conducted in a high volume interdisciplinary endoscopy department studied the effectiveness of ERCPs on children ranging in age from 3 weeks to just under 18 years. The researchers found the success rate of these procedures was 90.7%. They also found a low rate of side effects.

Doctors are more likely to use the ERCP procedure for diagnostic purposes with younger people. In older adults, physicians are more likely to use ERCP for treatment.

Compared with the complication rate of other endoscopic procedures, the complication rate for the ERCP procedure is fairly high. The most common complication is pancreatitis.

Pancreatitis is inflammation of the pancreas. It can be a very serious condition and requires medical care. According to a 2020 retrospective study, 16.5% of people who had the ERCP procedure developed pancreatitis in 2016.

If a person develops pancreatitis after an ERCP procedure, the resulting irritation is often due to the dye or the endoscope doctors use to perform the procedure.

After an ERCP, a person should seek immediate medical help if they notice the following:

  • severe pain in the belly that worsens
  • bloody bowel movements
  • fever
  • chills
  • nausea

Other potential complications include:

  • bleeding
  • infection
  • piercing the bowel wall

There is a slight risk of burns, tissue damage, and later cancer due to fluoroscopy-related radiation.

ERCP is a procedure that combines endoscopy and X-ray technology. Doctors use it to diagnose and treat issues with the pancreatic ducts, bile ducts, and gallbladder.

Doctors can conduct the procedure on people of all ages. They typically perform ERCP on an outpatient basis, often with the person only partially sedated. The recovery period is generally short and does not require more than a day away from regular activities.

The ERCP procedure has a reputation for being generally safe and effective. However, it has a higher risk of complications than other endoscopic procedures. Pancreatitis is the most common complication.