Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialist procedure used to examine and treat problems involving the bile ducts and pancreatic duct. It combines an endoscope with X-ray imaging and can allow a specialist to remove a stone, widen a narrowed area or place a stent when appropriate.
ERCP is different from a routine gastroscopy. It is selected after review of symptoms, blood tests and imaging because it can carry significant risks and often has a therapeutic purpose. A gastroenterologist or other appropriately trained specialist decides whether it is the right next step.
What ERCP does
The endoscope is passed through the mouth into the first part of the small intestine. The specialist identifies the opening of the bile and pancreatic ducts, guides a small instrument into the duct and uses contrast with X-ray imaging to see the anatomy. If a suitable problem is found, treatment may be performed during the same procedure.
Possible interventions include removing selected bile-duct stones, widening a narrowed area, taking a sample or placing a temporary or longer-term stent. The planned steps depend on the clinical question and what the specialist finds. ERCP is not simply a camera test of the stomach.
Modern imaging such as magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS), ultrasound or CT can provide important information without entering the ducts. The specialist decides whether one of these tests is enough or whether ERCP is needed for treatment or further assessment.
When a specialist may consider ERCP
A specialist may discuss ERCP when imaging and clinical findings suggest a bile-duct stone, blockage, narrowing, leak or selected pancreatic-duct problem that could benefit from endoscopic treatment. Jaundice, infection of the bile ducts or abnormal tests may lead to urgent assessment, but the appropriate procedure depends on the full clinical picture.
ERCP is not appropriate for every episode of abdominal pain or every abnormal liver test. Before referral, the clinician reviews symptoms, prior procedures, imaging, medicines and the urgency of the problem. If you are told ERCP is being considered, ask what question it is intended to answer and what treatment may be done.
Preparation and consent
Before the appointment, provide the specialist with previous imaging and reports, a current medicine list, allergies, heart or lung conditions, diabetes, kidney disease and any prior reaction to sedation. Tell the team if you may be pregnant. These details help them plan the procedure and discuss risks specific to you.
You will receive instructions about fasting, arrival time, medicines and transport. Do not stop blood thinners or diabetes medicines unless the prescribing or ERCP team provides a plan. If the written instructions are incomplete, call the service before the procedure date.
The consent discussion should cover the goal, possible interventions, alternatives and important risks, including pancreatitis, bleeding, infection, perforation and sedation-related problems. Ask how likely risks are in your particular situation and what the team does if a complication occurs.
What may happen on the day
The team checks your identity, health history, preparation and consent. ERCP is performed with sedation or anaesthesia according to the case and the service's plan. Monitoring continues during the procedure and in recovery.
A specialist advances the endoscope to the small intestine, accesses the duct opening and uses X-ray imaging to guide instruments. If treatment is planned, the specialist may remove a stone, take a sample, widen a narrowing or insert a stent. The procedure can take longer if treatment is complex.
Afterwards, staff observe you and explain the expected recovery and follow-up. The length of observation or admission depends on what was done and your clinical condition.
Risks, recovery and urgent symptoms
ERCP can cause complications. These include pancreatitis, bleeding, infection, a tear in the bowel or duct, and reactions to medicines used for sedation or anaesthesia. The chance of a complication depends on the reason for ERCP, the treatment performed and personal health factors. The specialist should explain your individual risk before you decide.
Follow the discharge advice, including when to eat, which medicines to take and how the stent or other treatment will be reviewed. Confirm how to obtain the procedure report and whom to contact if you feel unwell after going home.
Seek urgent medical care for severe or worsening abdominal pain, fever or chills, repeated vomiting, black stool, vomiting blood, fainting, breathing difficulty or another warning sign on your discharge sheet. Use the urgent contact number provided by your service.
