ERCP overview

Overview

ERCP (Endoscopic Retrograde Cholangiopancreatography) is a medical procedure that uses a thin, flexible tube with a camera to look at the bile ducts (tubes that carry bile from the liver) and the pancreas. It can also treat blockages, such as removing gallstones or placing a small tube called a stent to keep ducts open.

ERCP is a fairly common procedure, especially for people with bile duct blockages or certain pancreatic conditions.

It is used in adults and sometimes children who have problems with their bile ducts or pancreas, such as gallstones, narrowing of the ducts, or pancreatitis.

Symptoms

Common symptoms

• Yellowing of the skin or eyes (jaundice)
• Pain in the upper right or middle part of the stomach
• Nausea and vomiting
• Dark urine and pale stools

Symptoms in children

• Prolonged jaundice in newborns (yellow skin and eyes that does not go away)
• Poor feeding and weight loss
• Pale stools and dark urine

Symptoms in older adults

• Unexplained weight loss
• Jaundice with itching
• Vague abdominal discomfort that comes and goes

Causes

Main causes

• Gallstones that block the bile duct
• Narrowing or scarring of the bile ducts (strictures)
• Pancreatitis (inflammation of the pancreas)
• Tumours of the pancreas or bile ducts

Risk factors

• Being overweight or obese
• Having gallstones
• Heavy alcohol use
• Having a history of pancreatitis or bile duct problems
• Certain medical conditions like primary sclerosing cholangitis

When to see a doctor

See a doctor urgently if:

• If you have yellow skin or eyes along with fever and chills
• If you have severe stomach pain that does not go away
• If you vomit blood or have black stools

Book a routine appointment if:

• If you have mild jaundice or persistent itching without a clear cause
• If you have ongoing discomfort in your upper stomach after eating fatty foods
• If you have unexplained weight loss or loss of appetite

Diagnosis

Your doctor will first take your medical history and do a physical exam. They may order blood tests and imaging scans, such as an ultrasound or CT scan, to look for blockages or other issues. If these tests suggest a problem with your bile ducts or pancreas, they may recommend an ERCP to see the area clearly and treat it at the same time.

Tests that may be done

• Blood tests (to check liver and pancreas function)
• Ultrasound of the abdomen
• CT scan or MRI scan
• ERCP itself (done under sedation)

What to expect at your appointment

Before the ERCP, you will be asked not to eat or drink for several hours. You will be given medicine to help you relax (sedation). A thin, flexible tube with a camera is passed through your mouth, down your throat, into your stomach and the first part of your small intestine. A small tube goes into the bile ducts to inject dye for X-rays. If a blockage is found, the doctor can use tools on the endoscope to remove a stone or place a stent. The procedure usually takes 30 minutes to an hour, and you will need to rest for a few hours afterward.

Treatment

Treatment depends on what the ERCP finds. If there is a blockage, it can often be treated during the same procedure. Common treatments include removing gallstones, widening narrowed ducts, or placing a stent (a tiny tube) to keep a duct open. If the problem is more complex, further treatments may be needed.

Self-care at home

• After the ERCP, rest for the day and avoid driving or operating machinery for 24 hours due to sedation.
• Drink clear fluids when you feel ready, then gradually return to your normal diet as advised.
• Watch for signs of complications like fever, severe pain, or vomiting, and contact your doctor if these occur.

Medical treatments

If an infection is present, your doctor may prescribe antibiotics. If the procedure does not fully resolve the problem, you may need additional treatments such as medications to manage inflammation or to help dissolve small stones. Your doctor will explain the best option for your situation.

When is surgery considered?

In some cases, if the blockage cannot be treated safely during ERCP, or if there is a tumour or other serious condition, surgery may be needed. Surgery could involve removing the gallbladder (cholecystectomy) or bypassing the blocked duct.

Living with this condition

After a successful ERCP, most people feel better quickly. You may need to make small changes to your diet and lifestyle to prevent future problems. Follow-up appointments with your doctor are important to check that everything is healing well.

Lifestyle tips

• Maintain a healthy weight with a balanced diet and regular exercise.
• Limit alcohol consumption to reduce strain on your pancreas.
• Stay active, but avoid heavy lifting or strenuous activity for a few days after the procedure.

Diet and exercise

A low-fat diet can help reduce the risk of gallstones and ease digestion. Focus on fruits, vegetables, whole grains, and lean proteins. Regular exercise, like walking for 30 minutes most days, supports overall health.

Mental health and emotional wellbeing

It is normal to feel worried or anxious about having a procedure on your digestive system. Some people may feel stressed about the underlying condition. Talk to your doctor or a counsellor if you need support.

Prevention

Not all conditions that require ERCP can be prevented, but you can lower your risk of gallstones and pancreatitis by maintaining a healthy weight, eating a balanced diet, limiting alcohol, and not smoking.

Screening programmes

If you have a family history of bile duct or pancreatic problems, or certain conditions like primary sclerosing cholangitis, your doctor may recommend regular check-ups and imaging tests to catch problems early.

Complications

If left untreated

• Worsening jaundice and liver damage
• Severe infection in the bile ducts (cholangitis)
• Pancreatitis (inflammation of the pancreas)
• Spread of cancer if a tumour is present

Long-term outlook

With timely diagnosis and treatment, most people who need an ERCP have a very good outlook. Blockages can often be treated successfully, and many people return to their normal activities without long-term problems. If a more serious condition is found, treatment options are available to manage it and improve quality of life.

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