Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is short for endoscopic retrograde cholangiopancreatography. This specialized procedure uses a thin flexible tube (endoscope) to examine or treat the bile and pancreatic ducts, which carry fluids from the liver or pancreas to other organs. This image-guided procedure uses moving x-rays to follow the path of an injectable dye.

Doctors recommend ERCP to observe how the ducts are working and to check for diseases. They may treat a condition during the same ERCP session, for example to enlarge a bile duct opening or remove gallstones lodged in a bile duct.

Gastroenterologists, who specialize in diseases of the digestive system, perform minimally invasive procedures like ERCP at Penn Medicine. Our biliary and pancreatic disease care team uses the most advanced techniques and approaches to find the cause of your symptoms and create an individualized plan to bring you relief.

Your care team will provide preparation instructions that may include changes to your diet or medication schedule in the days leading up to the procedure. Be sure to discuss any allergic reactions you’ve had to iodine or other dyes used as part of the procedure.

On the day of the procedure, you can expect these steps:

• You’ll receive medications through an IV (intravenous) line to help you relax or go to sleep. A spray may be used to numb your throat, and a mouth guard will be placed in your mouth to protect your teeth. You’ll need to remove any dentures.
• The endoscope will be inserted through your mouth and into your food pipe (esophagus) and stomach until it reaches the part of the small intestine that is closest to the stomach. It’s normal to feel the urge to gag as the tube is passed down your esophagus or to feel the stretching of ducts as the scope is put in place.
• Your provider will pass a thin tube (catheter) through the endoscope and insert it into the ducts that lead to the pancreas and gallbladder. A special dye is injected into these ducts, and x-rays are taken. This helps the doctor examine gallstones, tumors, or any areas that have narrowed.
• If an issue is discovered, your doctor may treat it. For example, they may create a small incision and remove a blockage. Tiny instruments are placed through the endoscope and into the ducts to perform any treatments.
• The instruments and endoscope will be removed, and you’ll move to a recovery area as the relaxing medications wear off. Many people go home the same day, though for some types of ERCP treatments, you may stay overnight for observation.

It’s common to have some slight discomfort for about 24 hours after an ERCP procedure, including a sore throat and digestive bloating, gas, or cramping due to air placed into your stomach. Some general soreness may also persist for three or four days. Your care team will give you instructions on ways to relieve any pain safely, such as using acetaminophen or placing a heating pad on your belly. They’ll also advise you about over-the-counter medications to avoid.

You’ll have limits on your physical movement and dietary restrictions for a few days. You may be asked to eat lightly, drink plenty of fluids, and engage only in mild activity for the first 48 hours after the procedure.

While unusual symptoms are unlikely, contact your provider if you experience severe abdominal pain or bloating, bleeding from the rectum, black stools, nausea, vomiting, or a fever above 100°F. Your care team will provide additional treatment to make you more comfortable.

People across Pennsylvania and New Jersey rely on the expertise of Penn Medicine’s gastroenterology team for conditions of the bile and pancreatic ducts. Our ERCP procedures use less invasive, specialized techniques that provide the care you need to set you on the path to recovery most quickly. As a research hospital, we’re committed to using the latest diagnostic tools and treatments to resolve painful symptoms and keep you healthy.