Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

The vast majority of ERCP tests are performed for therapy of bile duct disorders. The tests are most commonly done with sedation, in the x-ray department.

Common Reasons for the Test:

  1. To relieve obstruction from gallstones in common bile duct (CBD) causing pain, infection (cholangitis) and/ or jaundice
  2. To relieve obstruction from narrowing (stricture) in CBD causing pain, infection (cholangitis) and/ or jaundice. A stricture may be due to a growth (tumour) in the bile duct or pancreas, or surrounding enlarged lymph nodes
  3. To remedy a bile leak complication following a cholecystectomy (surgery to remove gallbladder)


The alternatives to ERCP for reasons 1 & 2 above include a procedure that involves percutaneous (through the skin) needle puncture into the liver to access the bile duct (also called PTBD) or bypass surgery. These may not be feasible when patients are acutely unwell, unstable, unfit or have advanced tumour stage.

Preparing for the Test

  • Stop Clopidogrel (7 days) or Warfarin (5 days) before the test if instructed, and temporary Heparin injection may be necessary

On the Day of Test

  • Report any known allergy to iodine or x-ray dye, or the possibility of pregnancy
  • Clotting (INR) blood test is checked
  • Blood sugar (BM) is checked in patients with diabetes mellitus
  • A cannula (small plastic tube) is inserted into a vein, preferably in the right hand

In the Endoscopy/ X-Ray Room

  • A monitoring probe is attached to a finger
  • A nasal cannula is attached to a nostril for oxygen supplementation
  • Denture (if present) is removed
  • Plastic mouth guard is applied
  • Endoscope is introduced into the mouth

Drugs Commonly Used for the Test

Topical spray - Local anaesthetic throat spray
Injection - Sedatives (benzodiazepine, midazolam)
- Pain killer (morphine, commonly pethidine or fentanyl)
- Antibiotics (Tazocin, Co-amoxiclav, or oral Ciprofloxacin)
- Buscopan

Patient Position During the Test

Prone or semi-prone (see picture 1).
Left lateral (sometimes).

Picture 1

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Patient position during the test Prone or semi-prone

Can I Watch the Test?

This is not feasible as the head position faces away from the video and x-ray (fluoroscopy) monitors and the moderate deep sedation administered during ERCP.

Pain/ Discomfort

The opening of the bile duct may be enlarged to allow removal of gallstones or passage of a stent. This may involve an electrically heated wire (diathermy) or a balloon device passed through the endoscope.

A stent is an internal drainage tube made of plastic or flexible metal mesh. A temporary plastic pancreatic stent may be placed to help bile duct access and reduce the risk of pancreatitis. Plastic biliary stent(s) are inserted to ensure bile drainage, when large gallstones could not be completely removed, until a repeat attempt. Both plastic and metal biliary stents are used to treat bile duct stricture. These stents do not cause any discomfort. 

You may experience some discomfort from dilation with a balloon device, and sometimes during the removal of gallstones. Supplementary injection of sedative or painkiller (morphine) drugs will be given as necessary during the test for adequate control of pain or discomfort.

Specific Complications

There is a 1-2% risk of inflammation of pancreas (pancreatitis), which may be higher with some patient and procedure related risk factors. Due to the therapeutic nature of most ERCP tests, they are associated with complications of perforation (as with any therapeutic endoscopy test) and bleeding (about 2%). In severe cases of perforation or bleeding, surgery may become necessary.

If there is any suspicion of the above complications during or straight after the test (in recovery), patients will be admitted for close monitoring and/ or treatment.

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