ERCP: Indications, Preparation, Procedure, Complications, & More - Healthroid

ERCP: Indications, Preparation, Procedure, Complications, & More

Mayank Pandey
Written by Mayank Pandey on May 24, 2023

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a minimally invasive procedure that combines endoscopy and X-rays to diagnose and treat problems in the liver, bile ducts, pancreas, and gallbladder. During ERCP, a thin flexible tube with a camera at its tip (endoscope) is passed through the mouth into the duodenum (the first part of the small intestine). A dye is injected through the endoscope into the bile ducts or pancreatic ducts while X-ray images are taken.

ERCP can be used to diagnose conditions such as gallstones, tumors or blockages in the bile or pancreatic ducts, sphincter of Oddi dysfunction (a condition where muscles in the small intestine don’t relax appropriately), and chronic pancreatitis. It can also be used to remove gallstones from the bile ducts or place stents (small tubes) to keep blocked ducts open. The procedure usually takes about an hour to perform under sedation and has few risks when performed by experienced doctors.

Indications for ERCP

ERCP, or endoscopic retrograde cholangiopancreatography, is a diagnostic and therapeutic procedure used to evaluate and treat conditions affecting the bile ducts and pancreas. The indications for ERCP are varied but generally involve abnormalities in the biliary or pancreatic systems that cannot be adequately diagnosed or treated by other means.

One of the most common indications for ERCP is suspected obstruction of the bile ducts, which can cause jaundice, abdominal pain, and other symptoms. Other indications include evaluation of suspected tumors or strictures in the bile ducts or pancreas, acute or chronic pancreatitis with associated biliary tract disease, gallstone disease that cannot be managed with other treatments such as surgery or medication, and diagnosis and treatment of Sphincter of Oddi dysfunction.

In addition to these primary indications, ERCP may also be used in conjunction with other procedures such as liver biopsy or stent placement to diagnose and manage a range of disorders affecting the digestive system. However, like any medical procedure, ERCP carries some risks including infection, bleeding, and perforation of tissue walls within digestive organs among others. It is important that patients discuss these risks with their healthcare provider before undergoing an ERCP procedure.


Before procedure

Before undergoing an ERCP procedure, patients are advised to fast for at least 6 hours prior. This is because the procedure requires a clear view of the bile ducts and pancreas, which may be obstructed by food or liquid in the stomach. Patients are also typically asked to refrain from taking certain medications, such as blood thinners or anti-inflammatory drugs, in the days leading up to the procedure.

Patients will typically meet with their physician beforehand to discuss any concerns or questions they may have about the procedure. They will also be given instructions on how to prepare for the day of their ERCP appointment, including what time they should arrive at the hospital and what they should bring with them.

It is important for patients to follow all pre-procedure instructions carefully in order to ensure that they are properly prepared and that there are no complications during or after their ERCP. Failure to do so could result in delays, discomfort, or even cancellation of the procedure.

Procedure overview

ERCP or Endoscopic Retrograde Cholangiopancreatography is a minimally invasive procedure that examines the bile ducts, pancreas, and gallbladder using an endoscope. It is commonly used to diagnose and treat conditions such as gallstones, tumors, inflammation, and blockages in these organs. The patient is first given anesthesia to ensure they are comfortable during the procedure. Once the patient is asleep or sedated, the ERCP procedure involves the insertion of an endoscope through the mouth into the esophagus down to the stomach and duodenum.

Once in place, a small catheter is inserted through a side channel of the endoscope to inject contrast dye into the pancreatic and bile ducts. X-ray images are then taken to visualize any abnormalities present in these areas. If necessary, therapeutic interventions can be performed during this procedure such as removing stones or placing stents to relieve obstructions.

The procedure itself typically takes 45-60 minutes but may take longer depending on any additional interventions needed. Patients are usually sedated for comfort during ERCP procedures and will need someone else to drive them home afterward due to residual effects of anesthesia or sedation. Overall, ERCP is considered a safe and effective way for doctors to diagnose and treat various disorders affecting the pancreas, biliary tract, or liver.


One of the most common complications of ERCP is pancreatitis. It can occur in up to 5% of patients undergoing the procedure. Pancreatitis happens when digestive enzymes produced by the pancreas start digesting its own tissues, resulting in inflammation and severe pain. Other potential complications include bleeding from biopsy or sphincterotomy sites, perforation of the bile ducts, infection due to bacterial contamination during the procedure, and adverse reactions to anesthesia.

ERCP or endoscopic retrograde cholangiopancreatography is a medical procedure that uses an endoscope to examine the bile ducts, pancreatic ducts, and gallbladder. Though ERCP is generally considered a safe and effective diagnostic tool, there are some possible complications associated with it.

The risk factors for these complications vary depending on several factors such as age, underlying medical conditions like diabetes or liver disease, previous abdominal surgery history, and use of certain medications like blood thinners or aspirin before ERCP. To minimize these risks and ensure better outcomes following ERCP procedures, doctors should carefully evaluate each patient’s individual risk factors before performing this test.


After an endoscopic retrograde cholangiopancreatography (ERCP), patients will need to be closely monitored during the aftercare period. This is because the procedure involves inserting a flexible tube through the mouth and into the digestive system, which can cause discomfort and complications if not taken care of properly. Patients will typically remain in recovery until they are able to swallow fluids without difficulty, regain their normal level of alertness, and have stable vital signs.

During the aftercare period, patients may experience some common side effects such as bloating, cramping, or mild pain in the abdomen. These symptoms can be managed with over-the-counter pain relievers or prescribed medications by their physician. Patients should also avoid eating solid foods for several hours following an ERCP to allow their digestive system time to recover.

It is important for patients to closely follow any instructions given by their healthcare provider regarding aftercare procedures. They should also report any concerning symptoms such as fever or severe abdominal pain immediately to ensure prompt medical attention. With proper aftercare management, most patients are able to resume normal activities within a few days following an ERCP procedure.


In conclusion, ERCP is a minimally invasive diagnostic and therapeutic procedure that has revolutionized the management of various pancreaticobiliary disorders. It is highly effective in visualizing and treating obstructive jaundice, acute cholangitis, pancreatitis, biliary strictures, and stones. The procedure combines endoscopic and fluoroscopic techniques to access the common bile duct and pancreatic duct through the duodenum.

Although ERCP has numerous benefits, it may cause complications such as bleeding, perforation, infection, or pancreatitis. Therefore, it is essential to select appropriate candidates for the procedure based on their clinical presentation and imaging studies. Additionally, it is crucial to perform ERCP by experienced operators who are proficient in identifying and managing potential adverse events.

Overall, ERCP plays a critical role in the diagnosis and treatment of many pancreaticobiliary diseases. By applying proper patient selection criteria and technical expertise from skilled practitioners, ERCP can provide improved patient outcomes with fewer complications compared to traditional surgical approaches.

Published on May 24, 2023 and Last Updated on June 1, 2023 by: Priyank Pandey

Mayank Pandey
Written by Mayank Pandey on May 24, 2023

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