Endoscopic retrograde cholangiopancreatography/ERCP

As part of the treatment of certain diseases involving the gallbladder, bile ducts, pancreas and liver, he or she may perform a procedure called endoscopic retrograde cholangiopancreatography (ERCP). This involves the use of a long flexible instrument with a lighted tip through which dye may be injected so that the ducts in the biliary tree and pancreas can be visualised on an x-ray. The procedure may also be performed for diagnostic purposes in cases of jaundice, chronic pancreatitis or bile duct pathology.
Though you are conscious during the procedure, a sedative is given to help you to relax, as well analgesics (painkillers) and local anaesthetic to avoid discomfort. You are asked to swallow the endoscope which is then advanced down the gastrointestinal tract through the oesophagus, stomach and into the duodenum. Air is blown into the duodenum which may result in discomfort. Here the dye is injected into the the bile ducts which enter the duodenum, which may cause discomfort.
X-rays are taken during the procedure. If these show narrowing (stenosis) of ducts, a plastic stent may be inserted to improve drainage of bile. If gallstones are seen, these may be removed.
Biopsy (taking tissue samples) and sphincterotomy (cutting into a piece of muscle to open a sphincter) may also be performed.
The procudure lasts between 45 minutes and 2 hours.

Preparation
To facilitate the accuracy and safety of the procedure, you are required not to eat or drink anything after midnight the night before the procedure.
Any allergies must also be made known to the physician in order to avoid hypersensitivity reactions. Due to the effect of sedatives, it is unsafe to drive even if you feel capable and therefore arrangements must be made for transport home after the procedure.

Complications
Pancreatitis (inflammation of the pancreas) may occur in up to 5% of patients. Hypersensitivity reactions may occur due to the contrast medium. Sphincterotomy is associated with a relatively higher risk of perforation of the duodenum and bleeding, however these complications are rare.