Digestive Diseases and Nutrition

Endoscopic retrograde cholangiopancreatography (ERCP)

PancreasEndoscopic Retrograde Cholangio Pancreatography (ERCP) procedure is a real-time radiolgraphic examination of the bile ducts (small draining tubes), gallbladder and/or pancreatic duct. The procedure is performed by board-certified gastroenterologists (stomach and liver specialists) or by their trainees (also known as Fellows) who work under their direct supervision.

The instrument used for this procedure is called the side-viewing endoscope, a thin but long flexible tube that carries a high definition wide-angle side camera, a bright light source and working channels at its tip. The instrument allows the physician to insert a thin tube known as a cannula into the bile duct and/or pancreatic duct. Dye is injected through the cannula under x-ray imaging (fluoroscopy) so a picture of the bile/pancreatic ducts is obtained and tissue samples known as biopsies/brushings are taken.


The procedure is pain free as you will receive sedatives/pain medications to ensure your comfort. The instrument is inserted through the mouth.

ERCP helps your gastroenterologist evaluate and treat multiple biliary disorders such as bile duct obstruction due to stones or cancer, or pancreatic disorders such as pancreatitis or pancreatic cancer. It is an essential part of the evaluation of abdominal pain and abnormal liver tests. The procedure can be done on an outpatient or inpatient basis.

In preparation of the procedure, your physician may ask you to stop certain medications before your procedure. Otherwise, a period of 12-hour fasting is needed.

ERCP harbors some risk. The risks associated with this procedure can be related to sedation such as transient respiratory depression (slowness of breathing) and minor change in vital signs (blood pressure and heart rate). Pancreatitis (inflammation of the pancreas) occurs in 1-7% of patients depending on multiple factors. Infection rate is 1%; bleeding 7-20 per 1,000; perforation (tear) risk is 3-6 per 1,000; and risk of death is 1 in 500.

When you wake up from sedation you will be monitored for any adverse events for a period up to one hour. You may feel a little bloated from the air that is introduced through the instrument, but this will wear off in a short period of time. You will be permitted to carry on any normal activity for the remainder of the day except for driving a motorized vehicle so you will need an adult driver to pick you up that day.