Test Overview

An endoscopic
retrograde cholangiopancreatogram (ERCP) test checks the tubes (ducts) that drain the
liver,
gallbladder, and
pancreas. A
flexible, lighted scope (endoscope) and X-ray pictures are used.

The scope is put
through the mouth and gently moved down the throat. It goes into your
esophagus, stomach, and
duodenum until it reaches the point where the ducts
from the pancreas and gallbladder drain into
the duodenum. X-rays will then be taken.

ERCP can treat certain problems found during the
test. In some cases, your doctor can insert small tools through the scope to:

  • Take a sample of tissue (biopsy) from an abnormal growth. Then it can be checked for problems.
  • Remove a gallstone in the
    common bile duct.
  • Open a narrowed bile duct. A narrowed bile duct can
    be opened by inserting a small wire-mesh or plastic tube (called a stent)
    in the duct.

Why It Is Done

ERCP is done to:

  • Check lasting belly pain or
    jaundice.
  • Find
    gallstones or diseases of the liver, bile ducts, or
    pancreas.
  • Remove gallstones from the common bile duct if they are
    causing problems. These may include a blockage (obstruction), inflammation or infection of
    the common bile duct (cholangitis), or
    pancreatitis.
  • Open a narrowed bile duct or
    insert a drain.
  • Get a tissue sample for further testing
    (biopsy).
  • 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 told you to take your medicines on the day of the test, 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 medicine
    allergies, or
    asthma.
  • Are allergic to shellfish (shrimp,
    scallops, lobster). Also tell your doctor if you are allergic to iodine, such as that used in the
    contrast material for X-ray tests.
  • Have had a digestive tract study
    that used barium, such as a
    barium enema, within the last week.
  • Take a blood thinner, or if you have had bleeding problems. You may need to stop these medicines for a while before you have the test.

Talk to your doctor about any concerns you have about
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. You will also need to remove any dentures, jewelry, or contact lenses before you have this test.

How It Is Done

An endoscopic retrograde
cholangiopancreatogram (ERCP) is usually done by a gastroenterologist. This is a doctor who has special training in
diseases of the digestive system. The doctor must be trained in
endoscopy. A thin, flexible
fiber-optic endoscope (scope) is used.

This test is done in the hospital. You
may have to stay overnight if your doctor takes out gallstones or places a stent
during the test. Otherwise, you can go home after the
test.

An ERCP usually takes 30 to 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. This makes it
easier to insert the scope. Shortly before the test begins, an intravenous
(IV) line will be placed in a vein in your arm. You will get pain medicine
and a
sedative through the IV during the test. You may also
get an antibiotic through the IV.

You will need to lie on
your left side. Your head will be tilted slightly forward. A mouth guard may be
inserted to protect your teeth from the scope. The scope’s tip will be lubricated. The doctor will guide it into your mouth while gently pressing your
tongue out of the way. You may be asked to swallow to help move the tube along.
The scope is no thicker than many foods you swallow.

When the scope is
in your esophagus, your head will be tilted upright to help the scope slide
down. Then your doctor will slowly move the scope into your stomach
and duodenum. Your doctor looks at all three of these areas as the
scope moves forward. When it reaches your duodenum, you will be
turned over to lie flat on your belly.

A small amount of air will be
injected through the scope. This makes it easier for the doctor to see. The
doctor will move the scope forward until it reaches the point where the ducts from the
pancreas and gallbladder drain into the duodenum. A thin tube
called a catheter is then passed through the scope into that area. Then
contrast material is injected into the bile or pancreatic ducts. Several X-rays
are taken. You will stay on your belly until the X-rays are ready to view. If needed, the doctor may take more X-rays.

The doctor may insert small tools through the scope. This allows the doctor to take a tissue sample, remove a gallstone, open a narrowed bile duct, or place a stent.

When the test is done, the scope is slowly
withdrawn.

After the test

After the test, you
will be observed in a recovery room. If your throat was numbed
before the test, you will not be allowed to eat or drink until your throat is
no longer numb. You will need to be able to swallow without choking. You can then eat and drink normally.

If your doctor removed a gallstone or placed a stent during the test, you
may need to stay a night in the hospital. You cannot drive or return to work for 24 hours. If you can go home the day of the test, you will need to have someone drive you.

Your
doctor will check for signs of problems before you go
home.

After the test, you may feel bloated and notice a temporary change in your
bowel habits. This is because air was used to open the bile and
pancreatic ducts. Call your doctor if you have bleeding from the rectum or
if your stools look black or bloody.

How It Feels

You may notice a brief, sharp burning or
stinging when the IV is started in your arm. The
local anesthetic sprayed into your throat usually
tastes slightly bitter. It 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 belly cramps
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. You may not be able to remember much of what happens
during or for several hours after the test. You may have heavy eyelids,
trouble speaking, a dry mouth, or blurred vision for several hours after the
test.

You may feel flushed when the contrast material
is injected.

After the test

After the test, you may have gas
and feel bloated for a while. You may also have a dry and tickling throat, slight
hoarseness, or a mild sore throat for several days. Using throat lozenges and
gargling with warm salt water 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.

Risks

Complications are not common. But having this test may cause serious
problems, such as:

  • Inflammation of the pancreas.
    (This is called pancreatitis.)
  • Bleeding. This may occur if the pancreatic or bile
    ducts were widened, if a stent was placed, or if biopsies were taken.
  • Infection of the bile ducts, which may occur if gallstones
    were removed.
  • Infection of the blood. (This is called 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
right away if you:

  • Have nausea or vomiting.
  • Have new or increased belly
    pain.
  • Get a fever or chills.
  • Feel short of
    breath.
  • Are dizzy or feel like you may faint.

People who have serious heart disease and older adults
who have other chronic diseases have a greater chance of having problems from this
test. Talk to your doctor about your
specific risks.

Results

An endoscopic
retrograde cholangiopancreatogram test checks the tubes (ducts) that drain the
liver,
gallbladder, and
pancreas. A
flexible, lighted scope (endoscope) and X-ray pictures are used.

Your doctor may be able to tell you about some findings right after the test. But the
medicines used to relax you for the test may impair your memory. So your doctor
may tell you to call the next day for your results.

Endoscopic retrograde cholangiopancreatogram (ERCP)
Normal:
  • Contrast material shows normal structure and size of the bile ducts and the ducts that drain the
    liver,
    gallbladder, and
    pancreas.
  • The
    esophagus, stomach,
    and duodenum look normal.
  • Pressure in the ducts is normal.
Abnormal:
  • The ducts are
    narrowed or blocked. This may be caused by
    gallstones, scar tissue, inflammation, or
    cancer.
  • Inflammation, ulcers, infection, or pseudocysts are seen.
  • Cancer of the
    esophagus, stomach, duodenum, gallbladder, or pancreas is found.
  • Pressure in the ducts is not normal.

What Affects the Test

You may not be able to
have the test, or the results may not be helpful, if:

  • You have barium contrast material in your
    intestines. This may be from a
    barium enema test.
  • You have an infection such as pancreatitis or diverticulitis.
  • You are pregnant.
  • You can’t stay still during the test.

What To Think About

  • Depending on the ERCP results,
    you may need other tests to confirm a diagnosis. These may include angiography or laparoscopy.
  • If you have belly pain or jaundice, your doctor might suggest that you have a different test before you have ERCP. It may be a test that costs less or can be done without entering the body. This may include a
    CT scan, an
    MRI scan, or an
    abdominal ultrasound.
  • An imaging test called magnetic
    resonance cholangiopancreatogram (MRCP) can show the bile ducts and help diagnose medical conditions. But doctors can’t do biopsies or treatment during an MRCP.
  • An endoscopic ultrasound (EUS) test has a small
    ultrasound probe at the end of the scope. It may
    offer a more detailed view of parts of the digestive tract than ERCP. EUS also
    lets the doctor see certain organs of the body near the digestive
    tract. These include the pancreas and bile ducts. EUS may help diagnose noncancerous
    (benign) or cancerous (malignant) tumors of the esophagus, stomach, pancreas,
    and bile ducts.

References

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.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Jerome B. Simon, MD, FRCPC, FACP – Gastroenterology

Current as ofMay 5, 2017