Gastroenterology

Endoscopic Retrograde Cholangiopancreatography (ERCP)

About Your ERCP

What is an ERCP?

ERCP (Endoscopic Retrograde Cholangiopancreatography) is an examination of the pancreas, bile ducts, liver, and gallbladder for diseases. ERCP allows your physician to perform necessary treatments, such as enlarging a bile duct opening, removing gallstones lodged in the bile duct, inserting a stent (drain) in the duct or taking a biopsy specimen (tiny bit of tissue).

During ERCP, a flexible tube (duodenoscope) is passed through the mouth, esophagus (food tube) and stomach into the duodenum (first part of the small intestine) (see Figure 1). A small plastic tube is passed through the duodenoscope into the ampulla (opening where the bile and pancreatic ducts empty in the duodenum) (see Figure 2). X-ray dye is injected through the tube into the ducts. X-rays are then taken to study the ducts. Any necessary treatments can be performed at this time.

ERCP Figure 1 and 2

Digestive System Illustration Copyright A.D.A.M., Inc.

Plan to Do in Advance

  1. Medications, Vitamins and Supplements
    To properly prepare for your procedure, you may need to make certain changes to your daily medication routine.

    • If you take insulin, consult with your physician about making any necessary changes in you daily regimen.
    • If you take medications that contain aspirin or other anti-inflammatory drugs (such as Motrin, Advil, Indocin, or Feldene), we recommend that you stop taking them seven days before your procedure. They may increase your risk of bleeding after removal of a polyp or a biopsy during your ERCP by interfering with the normal clotting of your blood.
    • IMPORTANT: IF YOU ARE CURRENTLY TAKING COUMADIN OR HEPARIN, YOU MUST CHECK WITH YOUR PRESCRIBING PHYSICIAN BEFORE CHANGING OR INTERRUPTING YOUR DAILY ROUTINE.
    • Certain medications should be continued prior to your ERCP. If you take cardiac (heart) or anti-hypertensive (high blood pressure) pills, take them as you normally do with small sips of water.
  2. In addition to changes to your medication, you'll also need to:

    • Bring a list of all your medications (prescription medications, over-the-counter medications and eye drops) with you on the day of your procedure. You may bring the medication bottles themselves.
    • Be prepared to list and describe your ALLERGIES and REACTIONS to any medications.
  3. Because you will receive a relaxing medication during your procedure, you must arrange to have a responsible adult pick you up and/or accompany you home if you taking public transportation. University of Pennsylvania Health System policy requires that you make these arrangements, or your procedure will not be performed. You may not operate an automobile or other mechanical equipment until the day following your procedure.

On the Day Before Your Procedure

To ensure the most accurate results possible, it is important that you do not eat or drink anything after midnight on the day before your procedure. The exception is medication taken with small sips of water.

On the Day of Your Procedure

  • On the day of your ERCP, please come directly to the requested location at your scheduled arrival time and check in with the receptionist. Plan to spend several hours at the unit to allow time for your preparation, your procedure, and your recovery.
  • Before the procedure, a nurse will greet you and assist you with changing into a hospital gown. An IV will be placed in your arm. You will receive relaxing medications through the IV during the procedure. The duodenoscope will be passed through the mouth, esophagus, and stomach into the duodenum (first part of the small intestine). The physician will view the ducts by X-ray.

After Your Procedure

  • After the ERCP, you will be taken to the recovery area where you will be monitored until most of the effects of the relaxing medication have worn off. If certain therapeutic procedures are performed, you physician may recommend observation overnight in the hospital.
  • You may have some cramping or bloating as a result of the air placed into your stomach during the procedure.
  • The Endoscopist will discuss the results of your procedure with you prior to your discharge. You will receive discharge instructions on the day of the test.
  • Your endoscopy report and biopsy results will be sent to your referring physician.

If you would like to speak to a nurse regarding your procedure or preparation, or if you need to reschedule your procedure, please call the appropriate number:

  • Perelman Center for Advanced Medicine
    Procedure questions: 215-662-2122
    To reschedule: 215-349-8222
  • Penn Presbyterian Medical Center
    All questions: 215-662-8900

Please be aware that these instructions apply to patients scheduled for procedures at the Perelman Center for Advanced Medicine, Penn Presbyterian Medical Center and Penn Medicine Radnor. However, your doctor may give you different instructions or procedures. If you have any questions about your procedure, please contact your physician at the Digestive & Liver Center.