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Home > Wellness > Health Library > Endoscopic Retrograde Cholangiopancreatogram (ERCP)
retrograde cholangiopancreatogram (ERCP) is a test that combines the use of a
flexible, lighted scope (endoscope) with X-ray pictures to
examine the tubes that drain the
The endoscope is inserted
through the mouth and gently moved down the throat into the
esophagus, stomach, and
duodenum until it reaches the point where the ducts
from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into
ERCP can treat certain problems found during the
test. If an abnormal growth is seen, an instrument can be inserted through the
endoscope to obtain a sample of the tissue for further testing (biopsy). If a gallstone is present in the
common bile duct, the doctor can sometimes remove the
stone with instruments inserted through the endoscope. A narrowed bile duct can
be opened by inserting a small wire-mesh or plastic tube (called a stent)
through the endoscope and into the duct.
ERCP is done to:
Follow the instructions exactly about when to stop eating and drinking, or your test may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
If your doctor prescribed antibiotics before the test, take them as directed. You need to take the full course of antibiotics.
Tell your doctor if you:
Talk to your doctor about any concerns you have regarding
the need for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information formmedical test information form(What is a PDF document?).
You will be asked to empty your
bladder and remove any dentures, jewelry, or contact lenses before having an
An endoscopic retrograde
cholangiopancreatogram (ERCP) is done by a doctor trained in
endoscopy, usually a doctor who specializes in
diseases of the digestive system (gastroenterologist). A thin, flexible
fiber-optic endoscope is used.
ERCP is done in the hospital. You
may have to stay overnight if your doctor removes gallstones or places a stent
during the test. Otherwise, you will be allowed to go home after the
An ERCP usually takes between 30 and 60 minutes. You will be
in the recovery room 1 to 2 hours.
Your throat may be numbed with
an anesthetic spray, gargle, or lozenge to relax your gag reflex and make it
easier to insert the endoscope. Shortly before the test begins, an intravenous
(IV) line will be placed in a vein in your arm. You will be given pain medicine
sedative through the IV during the test. You may also
be given an antibiotic through the IV.
You will be asked to lie on
your left side with your head tilted slightly forward. A mouth guard may be
inserted to protect your teeth from the endoscope. The lubricated tip of the
endoscope will be guided into your mouth while the doctor gently presses your
tongue out of the way. You may be asked to swallow to help move the tube along.
The instrument is no thicker than many foods you swallow. Once the endoscope is
in your esophagus, your head will be tilted upright to help the scope slide
Your doctor will slowly move the endoscope into your stomach
and duodenum. Your doctor looks at your esophagus, stomach, and duodenum as the
scope moves forward. When the endoscope reaches your duodenum, you will be
turned over to lie flat on your abdomen. See a picture of the
placement of an endoscope during ERCP.
A small amount of air will be
injected through the scope to make it easier for the doctor to see. The
endoscope is moved forward until it reaches the point where the ducts from the
pancreas and gallbladder drain into the duodenum (the papilla). A thin tube
called a catheter is then passed through the endoscope into the papilla, and
contrast material is injected into the bile or pancreatic ducts. Several X-rays
are taken. You will remain on your abdomen while the X-rays are developed. If
necessary, additional X-rays may be taken.
called biopsy forceps or brushes, may be inserted through the endoscope to
collect samples. If a gallstone is seen during the test, the doctor can
sometimes remove it. A narrowed bile duct can be held open by inserting a small
wire-mesh or plastic tube called a stent through the endoscope and into the
When the test is completed, the endoscope is slowly
After the ERCP is completed, you
will be observed in a recovery room for 1 to 2 hours. If your throat was numbed
before the test, you will not be allowed to eat or drink until your throat is
no longer numb and you are able to swallow without choking. You can then resume
eating and drinking normally.
Unless you are staying in the
hospital, you will need to have someone drive you home after the test. You will
not be allowed to drive or to return to work for 24 hours.
doctor will make sure you do not have any signs of complications before you go
home. If your doctor removed a gallstone or placed a stent during the test, you
may need to stay in the hospital overnight.
You may notice a brief, sharp burning or
stinging sensation when the IV is started in your arm. The
local anesthetic sprayed into your throat usually
tastes slightly bitter and will make your tongue and throat feel numb and
swollen. Some people report feeling as though they cannot breathe sometimes
because of the tube in their throat. This is a false sensation caused by the
anesthetic. There is always plenty of breathing space around the tube in your
mouth and throat. Remember to relax and take slow, deep breaths.
You may gag, feel nauseated or bloated, or have mild abdominal cramping
as the tube is moved. If the discomfort is severe, alert your doctor with an
agreed-upon signal or tap on the arm. Even though you won't be able to talk
during the test, you can still communicate.
The IV medicines will
make you feel sleepy, and you may not be able to remember much of what happens
during or for several hours after the test. You may have heavy eyelids,
difficulty speaking, a dry mouth, or blurred vision for several hours after the
You may have a flushing sensation when the contrast material
After the test, you may have gas
and feel bloated for a while. You may also have a tickling, dry throat, slight
hoarseness, or a mild sore throat for several days. Throat lozenges and
gargling with warm saltwater can help relieve your throat symptoms.
Because of the IV medicines used during this test, do not drink alcohol,
drive, or sign any legal documents for 24 hours after the test.
An endoscopic retrograde cholangiopancreatogram
(ERCP) is a test that does have some risks. Having this test may cause serious
problems, such as:
After the test, call your doctor
immediately if you:
People with serious heart disease and older adults
with other chronic diseases have a greater chance of having problems from this
test. Although complications are not common, talk to your doctor about your
An endoscopic retrograde
cholangiopancreatogram (ERCP) is a test that combines the use of a flexible,
lighted scope (endoscope) with X-ray pictures to examine the tubes
that drain the
Your doctor may be able to
discuss some of the findings with you immediately after the test. But the
medicines used to relax you for an ERCP may impair your memory. So your doctor
may tell you to call the next day for your results.
Reasons you may not be able to
have the test or why the results may not be helpful include:
Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
April 8, 2011
E. Gregory Thompson, MD - Internal Medicine & Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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