Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas including: gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts, that carry bile from the liver to the gallbladder and small intestine, so they and the pancreas can be seen on x rays.

During the procedure, you will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the biliary ducts of and pancreas open into the upper portion of the small intestine. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.
Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are rare. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay in recovery until the sedative wears off. The physician will make sure you do not have signs of complications before you leave.