ERCP
(Endoscopic Retrograde Cholangio-Pancreatography)

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• What is ERCP?
• What kind of preparation is required?
• What can be expected during and after the procedure?
• What are the reasons for the examination?
• What are the side effects and risks of the procedure?

What is ERCP?

ERCP is a diagnostic test to examine the duodenum (the first portion of the small intestine), the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct), the bile ducts, the gallbladder and the pancreatic duct. The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope is flexible and can be directed and moved around the many bends of the stomach and intestine. Two types of duodenoscopes are currently available. A fiber-optic duodenoscope uses a thin fiber-optic bundle to transmit images to the lens at the viewing end of the instrument. A videoscope uses a thin wire with a chip at the tip of the instrument to transmit images to a TV screen. The duodenoscope is inserted through the mouth, to the back of the throat, down the food pipe, through the stomach and into the first portion of the small intestine (duodenum). Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the duodenoscope into the papilla of Vater, and into the bile ducts and/or the pancreatic duct. Contrast material (dye) is then injected and x-rays are taken of the bile ducts and the pancreatic duct. The open channel also allows other instruments to be passed through it in order to perform biopsies, to insert plastic or metal tubing to relieve obstruction of bile ducts caused by cancer or scarring, and to perform incision by using electrocautery (electric heat). For further information on the anatomy and physiology of bile production (by the liver) and circulation, please visit the Gallstones article.

The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, which is stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It also produces digestive juice which drains through the pancreatic duct into the papilla of Vater, and into the intestine.