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ERCP (Endoscopic Retrograde Cholangiopancreatography)
ERCP (Endoscopic Retrograde Cholangiopancreatography) is a highly specialised combined endoscopic and fluoroscopic procedure that diagnoses and treats conditions of the bile ducts and pancreatic duct — including gallstones, strictures, and tumours — providing effective relief without the need for major surgery.
Overview
ERCP uses a side-viewing flexible endoscope introduced through the mouth to reach the duodenum, where the bile duct and pancreatic duct open through the ampulla of Vater. Through this single endoscopic access the specialist performs sphincterotomy, stone extraction, stricture dilation, stent placement, tissue biopsy, and pressure measurements of the biliary and pancreatic systems with remarkable precision. ERCP has transformed the management of biliary and pancreatic disease, replacing many previously open surgical procedures with a minimally invasive endoscopic approach and providing same-day or next-day discharge for most patients.
Types of ERCP Procedures
ERCP encompasses a wide range of diagnostic and therapeutic interventions within the bile and pancreatic ducts, addressing specific clinical problems with precision and minimal invasiveness.
- Diagnostic ERCP with Cholangiography (imaging of the bile duct system)
- Endoscopic Sphincterotomy with Stone Extraction (removing common bile duct stones)
- Biliary Stent Placement (plastic or metal stent for bile duct obstruction or stricture)
- Pancreatic Duct Stenting (stent for pancreatic strictures or chronic pancreatitis)
- ERCP with Tissue Biopsy (brush cytology or forceps biopsy of strictures)
Risk Factors for Bile Duct Disease Requiring ERCP
Bile duct disease requiring ERCP intervention arises from various conditions affecting the biliary system. Early diagnosis and treatment prevents progression to serious complications.
- Choledocholithiasis — gallstones migrating from the gallbladder into the common bile duct
- Biliary strictures from previous surgery, chronic pancreatitis, or cholangiocarcinoma
- Primary sclerosing cholangitis causing progressive fibrosis of bile ducts
- Pancreatic tumours obstructing the common bile duct at the pancreatic head
- Post-operative bile duct injuries or leaks following cholecystectomy
- Gallbladder disease and cholelithiasis predisposing to duct stone migration
Bile Duct Disease Symptoms
Bile duct obstruction produces a recognisable symptom complex that should prompt urgent gastroenterological evaluation. Timely ERCP intervention relieves obstruction and prevents serious complications.
- Jaundice — yellowing of the skin and whites of the eyes
- Dark-coloured urine and pale clay-coloured stools indicating biliary obstruction
- Right upper quadrant abdominal pain, often colicky in nature
- Fever, chills, and rigors indicating cholangitis (infected bile duct obstruction)
- Nausea and vomiting associated with biliary colic
- Itching (pruritus) from bile salt accumulation in the skin
- Elevated liver enzymes, bilirubin, and alkaline phosphatase on blood testing
- Dilated bile ducts on ultrasound or CT imaging
Key Benefits
Discover the advantages of choosing our ercp (endoscopic retrograde cholangiopancreatography) services.
Relieves bile duct obstruction and the jaundice, itch, and pain caused by gallstones or strictures
Extracts common bile duct stones without requiring open abdominal surgery
Rapidly treats life-threatening ascending cholangitis through urgent biliary decompression
Stent placement provides effective palliation of malignant bile duct obstruction
Short procedure time with most patients discharged the same or next day
Clinical Features
The technology, techniques and clinical approach behind our ercp (endoscopic retrograde cholangiopancreatography).
Combines diagnostic cholangiography with therapeutic intervention in a single endoscopic session
Sphincterotomy, stone extraction, stricture dilation, and stent placement all possible at ERCP
Fluoroscopic real-time imaging guides precise cannulation and therapeutic manoeuvres
Avoids open bile duct surgery for the majority of common bile duct stone presentations
Performed under conscious sedation or general anaesthesia based on patient preference and risk
Preparation Instructions
- Fast for 6 to 8 hours before the procedure with no food or water
- Complete blood tests including CBC, coagulation, liver and kidney function
- Stop anticoagulants 5 to 7 days before the procedure as directed
- Inform the endoscopist of all medications, especially blood thinners, diabetes medications, and contrast dye allergies
- Diabetic patients must receive specific guidance on insulin management on the procedure day
- Arrange transport home as you will not be fit to drive after sedation
- Bring all previous imaging including ultrasound, CT, and MRCP reports
- Complete a pre-procedure sedation assessment if required by the endoscopy unit
The Procedure
Step-by-step guide to what you can expect during your ercp (endoscopic retrograde cholangiopancreatography) procedure.
Specialist Biliary Assessment
Your gastroenterologist reviews your symptoms, liver function tests, abdominal ultrasound, and MRCP findings to confirm the precise location and nature of your bile duct or pancreatic duct problem — whether gallstone, stricture, or tumour — and plans the specific ERCP intervention that will provide the most effective treatment.
Informed Consent and Preparation Review
Our team reviews your medications, kidney function, coagulation status, and allergy history with you. Blood thinners are adjusted as needed and you receive specific guidance on fasting, diabetes medication management, and antibiotic requirements before the procedure to ensure your safety.
Comfortable Sedation and Endoscope Positioning
You receive conscious sedation or general anaesthesia so you are completely comfortable throughout. The duodenoscope — a side-viewing flexible endoscope — is gently passed through your mouth, through the oesophagus and stomach, and positioned precisely at the second part of the duodenum.
Cannulation and Contrast Injection
Your endoscopist carefully identifies the ampulla of Vater and gently advances the cannula into the desired duct using precise technique. Contrast dye is injected under fluoroscopic imaging to visualise the entire bile duct and pancreatic duct anatomy in real time on the X-ray screen.
Therapeutic Intervention
The planned treatment is performed with precision — whether sphincterotomy to widen the opening, stone extraction with a Dormia basket or balloon, stricture dilation with a graduated series of dilators, or stent placement to re-establish bile duct drainage. Each step is carefully monitored with fluoroscopy and adjusted as needed.
Recovery and Monitoring for Complications
You recover in the endoscopy recovery area for 2 to 4 hours with monitoring of vital signs, abdominal symptoms, and post-procedure comfort. Your team explains the procedure findings clearly before discharge and provides written instructions on warning signs of post-ERCP pancreatitis requiring urgent medical attention.
What to Expect
ERCP is performed under conscious sedation or general anaesthesia — you will be completely comfortable and unaware during the entire procedure. The duodenoscope is passed through the mouth to the duodenum, the bile and pancreatic ducts are cannulated with contrast for X-ray visualisation, and the therapeutic intervention — stone removal, stenting, or dilatation — is performed with precision. The procedure takes 30 to 90 minutes and most patients recover within 1 to 2 hours, discharged the same day or after a short overnight observation.
Recovery
Rest for the remainder of the procedure day and start with clear fluids before progressing to a light diet. Monitor for post-ERCP pancreatitis — upper abdominal pain that builds after the procedure, nausea, and vomiting — and report this to your medical team immediately. Take all prescribed medications including antibiotics as directed and follow instructions on resuming anticoagulants. Attend your follow-up to review procedure findings, confirm stent function if applicable, and plan further management.
Frequently Asked Questions
Common questions about ercp (endoscopic retrograde cholangiopancreatography).
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