UNC Health Talk

What to Know if You Need an ERCP Procedure

There are medical tests and procedures you’ve heard of: colonoscopies and MRIs, biopsies and EKGs. But if your doctor says you need an ERCP—that stands for endoscopic retrograde cholangiopancreatography—you’ll probably wonder what that is.

The ERCP procedure treats problems of the upper gastrointestinal (GI) tract using X-rays and an endoscope, a thin, flexible tube that looks inside the esophagus and stomach.

“ERCPs are a very powerful, nonsurgical way of treating bile duct and pancreatic disorders,” says Todd Baron, MD, director of advanced therapeutic endoscopy at UNC Health. About 600,000 are performed in the U.S. each year.

Common Reasons to Have an ERCP

ERCP procedures target the duodenum, the first part of the small intestine. Here, food from your stomach mixes with bile from the gallbladder and enzymes from the pancreas, both of which aid digestion. Gallbladder bile and pancreatic enzymes are delivered to the duodenum via ducts, or tubes. When those ducts narrow or clog, an ERCP procedure can restore the flow of these important fluids.

“One of the most common reasons for an ERCP is a stone in the bile duct. These stones mostly originate in the gallbladder and make their way into a duct,” Dr. Baron says. Other reasons the ducts could be blocked include pancreatic cancer or other cancers. In some cases, the bile duct is leaking fluid after surgery or trauma.

Blockage from stones or leakage of the duct can be treated with ERCP.

What Happens During an ERCP Procedure?

Think of an endoscopy as similar to a minimally invasive surgery, Dr. Baron says.

During ERCP, an endoscope is carefully fed into the mouth and down the esophagus to the point in the digestive tract that the doctor is trying to reach. For an ERCP, that would be the duodenum. That’s why endoscopes used in an ERCP are called duodenoscopes.

Using the duodenoscope’s light and camera, doctors guide it into place, blowing air into the stomach and duodenum to expand the area and see more clearly. From there, the doctor uses the scope to inject a dye into the ducts that makes them visible for X-ray imaging, which helps produce a “road map” for the doctor, Dr. Baron says.

Once the issue is determined, tools are passed through the duodenoscope to open blocked or narrowed ducts, break up or remove stones, perform a biopsy, remove tumors or insert stents.

What You Might Experience with an ERCP

ERCP procedures are performed at hospitals and outpatient centers. Talk to your doctor about what you need to do to prepare for an ERCP, such as fasting or temporarily skipping some medications. You also will need to arrange a ride home because of the medications used to make sure you don’t feel anything during the procedure. The procedures are performed under sedation given by an anesthesiologist or nurse anesthetist, Dr. Baron says.

Healthcare staff will monitor you closely during the procedure, which usually lasts one to two hours.

After the procedure, you will stay for an additional one to two hours until the sedation wears off. Your doctor will share the results of the procedure with you at that time. If a biopsy is conducted, results of that test may take longer to receive.

You can expect some bloating or nausea immediately after an ERCP. A sore throat is normal for a day or two. You may have trouble swallowing after the procedure, so liquids or soft foods are recommended until you feel back to normal. Occasionally, hospitalization is needed.

Risks of an ERCP Procedure

ERCPs are generally considered effective and safe. Risks and complications vary depending on the difficulty of the procedure, but it is thought that 5 to 10 percent of ERCPs result in complications for patients. Pancreatitis and excessive bleeding are two of the most common complications. Infections are a documented risk as well, sometimes caused by bacteria found on the duodenoscope.

“Duodenoscopes are harder to clean and disinfect than a standard endoscope because there are more working parts that are quite intricate,” Dr. Baron says. “Living organisms can get into the nooks and crannies of the scopes, and even with extensive cleaning and sterilization, they cannot be reached.”

This issue has led to the creation of single-use duodenoscopes that are used once and discarded.

“We are one of a few centers across the country that are using the single-use duodenoscope technology,” Dr. Baron says. “It is new, and we are working to understand if it is effective in a range of ERCP procedures, including the most complex cases.”

While these duodenoscopes are a relatively new tool for doctors to use for an ERCP, they are a promising advancement that could nearly eliminate one of the risks of the procedure.


If you need an ERCP procedure, find a doctor here.