retrograde cholangiopancreatogram (ERCP) is a test that combines the use of a
flexible, lighted scope (endoscope) with X-ray pictures to
examine the tubes that drain the
The endoscope is inserted
through the mouth and gently moved down the throat into the
esophagus, stomach, and
duodenum until it reaches the point where the ducts
from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into
ERCP can treat certain problems found during the
test. If an abnormal growth is seen, an instrument can be inserted through the
endoscope to obtain a sample of the tissue for further testing (biopsy). If a gallstone is present in the
common bile duct, the doctor can sometimes remove the
stone with instruments inserted through the endoscope. A narrowed bile duct can
be opened by inserting a small wire-mesh or plastic tube (called a stent)
through the endoscope and into the duct.
gallstones or diseases of the liver, bile ducts, or
Remove gallstones from the common bile duct if they are
causing a problem such as blockage (obstruction), inflammation or infection of
the common bile duct (cholangitis), or
Open a narrowed bile duct or
insert a drain.
Get a tissue sample for further testing
Measure the pressure inside the bile ducts (manometry).
How To Prepare
Follow the instructions exactly about when to stop eating and drinking, or your test may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
If your doctor prescribed antibiotics before the test, take them as directed. You need to take the full course of antibiotics.
Tell your doctor if you:
Have hay fever, hives, food or medication
Are allergic to shellfish (shrimp,
scallops, lobster), the iodine used in the
contrast material for X-ray tests, or any other
substance that contains iodine.
Have had a digestive tract study
that used barium, such as a
barium enema, within the last week.
taking blood-thinning medicines, such as aspirin or warfarin (Coumadin).
Talk to your doctor about any concerns you have regarding
the need for the test, its risks, how it will be done, or what the results will
mean. To help you understand the importance of this test, fill out the
medical test information form(What is a PDF document?).
You will be asked to empty your
bladder and remove any dentures, jewelry, or contact lenses before having an
How It Is Done
An endoscopic retrograde
cholangiopancreatogram (ERCP) is done by a doctor trained in
endoscopy, usually a doctor who specializes in
diseases of the digestive system (gastroenterologist). A thin, flexible
fiber-optic endoscope is used.
ERCP is done in the hospital. You
may have to stay overnight if your doctor removes gallstones or places a stent
during the test. Otherwise, you will be allowed to go home after the
An ERCP usually takes between 30 and 60 minutes. You will be
in the recovery room 1 to 2 hours.
Your throat may be numbed with
an anesthetic spray, gargle, or lozenge to relax your gag reflex and make it
easier to insert the endoscope. Shortly before the test begins, an intravenous
(IV) line will be placed in a vein in your arm. You will be given pain medicine
sedative through the IV during the test. You may also
be given an antibiotic through the IV.
You will be asked to lie on
your left side with your head tilted slightly forward. A mouth guard may be
inserted to protect your teeth from the endoscope. The lubricated tip of the
endoscope will be guided into your mouth while the doctor gently presses your
tongue out of the way. You may be asked to swallow to help move the tube along.
The instrument is no thicker than many foods you swallow. Once the endoscope is
in your esophagus, your head will be tilted upright to help the scope slide
Your doctor will slowly move the endoscope into your stomach
and duodenum. Your doctor looks at your esophagus, stomach, and duodenum as the
scope moves forward. When the endoscope reaches your duodenum, you will be
turned over to lie flat on your abdomen. See a picture of the
placement of an endoscope during ERCP.
A small amount of air will be
injected through the scope to make it easier for the doctor to see. The
endoscope is moved forward until it reaches the point where the ducts from the
pancreas and gallbladder drain into the duodenum (the papilla). A thin tube
called a catheter is then passed through the endoscope into the papilla, and
contrast material is injected into the bile or pancreatic ducts. Several X-rays
are taken. You will remain on your abdomen while the X-rays are developed. If
necessary, additional X-rays may be taken.
called biopsy forceps or brushes, may be inserted through the endoscope to
collect samples. If a gallstone is seen during the test, the doctor can
sometimes remove it. A narrowed bile duct can be held open by inserting a small
wire-mesh or plastic tube called a stent through the endoscope and into the
When the test is completed, the endoscope is slowly
After the test
After the ERCP is completed, you
will be observed in a recovery room for 1 to 2 hours. If your throat was numbed
before the test, you will not be allowed to eat or drink until your throat is
no longer numb and you are able to swallow without choking. You can then resume
eating and drinking normally.
Unless you are staying in the
hospital, you will need to have someone drive you home after the test. You will
not be allowed to drive or to return to work for 24 hours.
doctor will make sure you do not have any signs of complications before you go
home. If your doctor removed a gallstone or placed a stent during the test, you
may need to stay in the hospital overnight.
How It Feels
You may notice a brief, sharp burning or
stinging sensation when the IV is started in your arm. The
local anesthetic sprayed into your throat usually
tastes slightly bitter and will make your tongue and throat feel numb and
swollen. Some people report feeling as though they cannot breathe sometimes
because of the tube in their throat. This is a false sensation caused by the
anesthetic. There is always plenty of breathing space around the tube in your
mouth and throat. Remember to relax and take slow, deep breaths.
You may gag, feel nauseated or bloated, or have mild abdominal cramping
as the tube is moved. If the discomfort is severe, alert your doctor with an
agreed-upon signal or tap on the arm. Even though you won't be able to talk
during the test, you can still communicate.
The IV medicines will
make you feel sleepy, and you may not be able to remember much of what happens
during or for several hours after the test. You may have heavy eyelids,
difficulty speaking, a dry mouth, or blurred vision for several hours after the
You may have a flushing sensation when the contrast material
After the test
After the test, you may have gas
and feel bloated for a while. You may also have a tickling, dry throat, slight
hoarseness, or a mild sore throat for several days. Throat lozenges and
gargling with warm saltwater can help relieve your throat symptoms.
Because of the IV medicines used during this test, do not drink alcohol,
drive, or sign any legal documents for 24 hours after the test.
An endoscopic retrograde cholangiopancreatogram
(ERCP) is a test that does have some risks. Having this test may cause serious
problems, such as:
Inflammation of the pancreas
Bleeding, which may occur if the pancreatic or bile
ducts are widened during the procedure or if biopsies are taken during the
Infection of the bile ducts, which may occur if gallstones
Infection of the blood (sepsis).
An abnormal heart rhythm.
A puncture of
the esophagus, stomach, duodenum, bile duct, or pancreatic duct. If this
happens, you will need to have surgery to repair the puncture.
Problems caused by anesthesia.
After the test
After the test, call your doctor
immediately if you:
Have nausea or vomiting.
Have new or increased belly
Develop a fever or chills.
Feel short of
Are dizzy or feel like you may faint.
People with serious heart disease and older adults
with other chronic diseases have a greater chance of having problems from this
test. Although complications are not common, talk to your doctor about your
An endoscopic retrograde
cholangiopancreatogram (ERCP) is a test that combines the use of a flexible,
lighted scope (endoscope) with X-ray pictures to examine the tubes
that drain the
Your doctor may be able to
discuss some of the findings with you immediately after the test. But the
medicines used to relax you for an ERCP may impair your memory. So your doctor
may tell you to call the next day for your results.
An imaging test, a magnetic
resonance cholangiopancreatogram (MRCP), can be used to view the bile ducts and
to diagnose medical conditions. MRCP doesn't allow biopsies or treatments to be
done during the test.
Another test, endoscopic ultrasound (EUS),
uses a small
ultrasound probe at the end of the endoscope and may
offer a more detailed view of parts of the digestive tract than ERCP. EUS also
allows the doctor to see certain organs of the body adjacent to the digestive
tract, such as the pancreas and bile ducts. EUS may help diagnose noncancerous
(benign) or cancerous (malignant) tumors of the esophagus, stomach, pancreas,
and bile ducts.
If your doctor removes a gallstone or places a
stent during your ERCP, you may need to stay in the hospital
Because air is used during ERCP to open the bile and
pancreatic ducts, you may feel bloated and notice a temporary change in your
bowel habits. Notify your doctor if you experience bleeding from the rectum or
your stools look black or bloody.
Depending on the ERCP results,
you may need other tests, such as angiography or laparoscopy, to confirm a
diagnosis. Surgery may be needed to treat a problem found with ERCP.
Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
Pagana KD, Pagana TJ (2010). Mosby’s Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.
Primary Medical Reviewer
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer
Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
How this information was developed to help you make better health decisions.