Physicians at The London Clinic use Endoscopic Retrograde Cholangiopancreatography (ERCP) to diagnose and treat a range of conditions that can affect your digestive system.

The word endoscopic refers to the use of an endoscope, which is the long, thin, tube with a minute video camera that your physician uses to explore inside your digestive system.

Retrograde refers to the fact that a dye is injected to help your bile and pancreatic duct show up better on an X-Ray.

Finally, cholangiopancreatography means the process of taking the X-Rays.

Why would I need an ERCP?

If you have pain in your abdomen, jaundice, or other abnormalities that show up in blood tests, your doctor may recommend that you have an ERCP.

The procedure is used to diagnose and treat blockages of the bile or pancreatic duct that may be caused by:

  • Gallstones blocking the bile duct.
  • Tumours pressing against the pancreatic or bile ducts, or encircling them and squeezing them shut.
  • Scarring or narrowing of the duct as a result of another condition.
  • Sphincter of Oddi dyskinesia.

Having an ERCP: what to expect

An ERCP is a relatively short procedure, but its specific time can vary from around 30 minutes to over an hour. An ERCP is performed using a local anaesthetic and a sedative, which is injected into your vein. You will be awake rather than unconscious during the procedure and you will feel very drowsy and relaxed.

To prepare you for the procedure, your doctor will start by spraying a local anaesthetic into your throat so that it becomes numb. After this, you’ll be given an intravenous sedative so that you’re relaxed while the procedure is done.
Once the sedative has taken effect, your doctor will introduce the first section of the endoscope through your mouth and into your oesophagus. The endoscope is then moved forwards into your stomach until it reaches the top part of your small intestine, your duodenum.

Once the endoscope is in place, your doctor will look at your bile and pancreatic ducts by viewing images returned to a TV monitor attached to the endoscope.

Depending on what’s being investigated, your doctor will then use instruments that can be introduced through a channel inside the endoscope to do one of the following:

  • Inject a dye into the bile and pancreatic ducts to make them easier to see on an X-ray. This can show if either duct is abnormal or inflamed.
  • Take a tissue sample, called a biopsy, from the lining of one of your digestive organs.
  • If you have gallstones, your doctor can widen the opening of the bile duct by cutting it open in a procedure called a sphincterotomy. This allows the stone to be moved into your small intestine and pass out of your body naturally via a bowel movement.
  • If your bile duct is blocked or narrowed, it can be stretched or widened using a balloon dilator, and a small stent (a plastic or metal tube) can be put in place to keep the duct open while it heals.

What are the complications with an ERCP?

Although an ERCP is a fairly complex procedure, in most cases there are no associated side effects. In some cases, you may have a mild sore throat, or feel lethargic due to the sedative your doctor gives you beforehand to relax you during the procedure.

There is a small chance that you may experience more significant ERCP complications:

  • There is a 2-4 % chance of developing acute pancreatitis (inflammation of the pancreas), which usually starts within 6-8 hours of having the procedure. This causes severe upper abdominal pain, which goes through to your back.
  • If a cut is made to the sphincter, there is a 1 % chance of bleeding and a 1-2 % chance of developing infected bile.