Pancreatic and Bile Duct Examination (Endoscopic Retrograde Cholangiopancreatography)

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that enables your physician to examine the pancreatic and bile ducts. During the procedure, the doctor inserts a long, flexible, tube called the endoscope through your mouth, into your stomach and upper part of the small intestine (duodenum).

In the duodenum a small plastic tube is passed through the endoscope and into this opening a small opening called the ampulla. Dye is injected for contrast, and X-rays are taken to study the ducts of the pancreas and liver.

When is ERCP used?

Doctors use ERCP to diagnose and treat issues that may exist within the bile and pancreatic ducts. For diagnosis alone, doctors will usually use non-invasive tests such as magnetic resonance cholangiopancreatography (MRCP) – a type of magnetic resonance imaging (MRI to diagnose many problems of the bile and pancreatic ducts.

Also, when you bile or pancreatic ducts are narrowed or blocked by gallstones in your gallbladder and common bile ducts, doctors will perform ERCP to alleviate the problem. Infections, acute pancreatitis, chronic pancreatitis, trauma or surgical complications in your bile or pancreatic ducts, tumours or cancer in the bile and pancreatic ducts will also warrant an ERCP.

How to Prepare for ERCP

Before your procedure, talk to your doctor about any medication you are currently taking, both prescription and over the counter, as some medication may interfere with the procedure. It is also wise to inform the doctor if you are pregnant or suspect you may be pregnant.

You should also arrange for a ride home, because due to the anaesthesia, you cannot drive for some time after the procedure.

The doctor may ask you not to eat, drink, smoke or even chew gum for about 8 hours before your procedure. This is to ensure a clear view of your gastrointestinal tract.

What Happens During a Pancreatic and Bile Duct Examination?

During ERCP, doctors will first offer a sedative intravenously for relaxation. The doctor will then give you a liquid anesthetic to gargle or they will spray anesthetic on the back of your throat to help numb the throat and prevent gagging during the procedure.

The doctor will insert the endoscope down your throat, through your stomach, and into your duodenum. The endoscope pumps air into your stomach and duodenum, giving the doctor a clear view in the monitor fed by the camera that attaches to the endoscope.

The doctor will inject a special dye called contrast medium into the ducts to make them visible during x-ray. Then they will use x-ray imaging to examine the bile and pancreatic ducts and identify narrowed blockages.

During the procedure, the doctor may use tiny tools that go through the endoscope, to

  • open blocked or narrowed ducts
  • break up or remove gallstones.
  • perform a biopsy or remove tumours in the ducts.
  • insert tiny tubes that are left in narrowed ducts to hold them open, called stents.

After The Procedure

After ERCP, you may need to rest in the hospital for a few hours until the sedation wears off. You may also experience bloating and nausea, and a sore throat for a short period after the procedure. Once swallowing returns to normal, you can go back to your usual diet.

If you experience any abnormal symptoms post procedure, seek immediate medical attention as there could be complications that arouse from the procedure.