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This is an examination of the bile and pancreatic ducts, allowing the diagnosis and treatment of blockages (strictures), stones and other problems.

Physicians at The London Clinic use ERCP to diagnose and treat a range of conditions that can affect your liver, biliary system and pancreas.

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 or instruments are passed up the bile duct or and pancreatic duct to allow diagnosis or treatment.

Finally, cholangiopancreatography means the process of taking the X-Rays of the bile duct or pancreatic duct. 

Why would I need an ERCP?

If you have pain abnormalities following blood tests, and scans which support a problem in your bile ducts or pancreatic duct, 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 sedative, which is injected into your vein. You will feel drowsy but are not unconscious during the procedure and you will feel very drowsy and relaxed.

Occasionally your doctor may advise that the procedure is performed with an anaesthetist, with a full general anaesthetic.

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
  • Depending on the problem, your doctor may need to widen the opening of the bile duct by cutting it open in a procedure called a sphincterotomy. This allows the a stone to be removed into your small intestine and pass out of your body naturally via a bowel movement, or a stent to be inserted.
  • If your bile duct is blocked or narrowed, it may be necessary to widen this using a balloon dilator, and/or a small stent (a plastic or metal tube) put in place to keep the duct open and improve drainage of bile.

Sometimes an additional technique may be advised by your doctor, called cholangioscopy.  This involves the insertion of a tiny 3mm camera into the bile duct through the ERCP endoscope.  Your doctor will discuss any need for this prior to your procedure.

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 six to eight 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.

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