ERCP: Treating Bile Duct Stones and Blockages Without Surgery

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a specialized procedure that diagnoses and treats problems in the bile ducts and pancreatic duct, such as stones, narrowing (strictures), and blockages, often without surgery.

Who performs ERCP: Dr. Dana Pan performs ERCP at our practice.

What the name means

• Endoscopic: uses an endoscope, a thin, flexible tube with a camera
• Retrograde: dye is injected backward up into the ducts
• Cholangio: the bile ducts
• Pancreatography: X-ray pictures of the pancreatic duct

Why ERCP is done

• Bile duct stones that have moved out of the gallbladder (see gallstones and pancreatitis)
• Blocked or narrowed bile ducts from tumors, scarring, or primary sclerosing cholangitis, often treated with a stent
• Jaundice (yellow skin or eyes) or infection of the bile ducts (cholangitis) caused by a blockage
• Bile leaks after gallbladder surgery
• Some causes of pancreatitis, such as stones in the pancreatic duct
• Biopsies or brushings of a stricture to check for cancer

Because ERCP has some risk, it is used mainly for treatment. When the diagnosis is unclear, an MRI of the bile ducts (MRCP) or endoscopic ultrasound is often done first.

How to prepare

• Tell your doctor about all medicines, supplements, and allergies, especially blood thinners, diabetes medicines, weight-loss injections, and any allergy to iodine or X-ray dye.
• Tell your doctor about heart or lung problems, diabetes, bleeding problems, a pacemaker, or past stomach surgery (such as gastric bypass).
• Do not eat or drink for at least 6 hours before, or as instructed.
• Arrange for an adult to drive you home.

What to expect during the procedure

ERCP is usually done in a hospital because it needs X-ray equipment. You receive sedation or general anesthesia. The endoscope is passed through your mouth and stomach into the duodenum, where the bile and pancreatic ducts drain. A thin tube is passed into the duct, and dye is injected so it shows on X-ray. The doctor can then:

• Make a small cut to widen the duct opening (sphincterotomy)
• Remove stones with a balloon or basket, or break up large stones
• Place a plastic or metal stent to keep a duct open
• Take biopsies or brushings

After the procedure

• You will be watched until the sedation wears off. Many patients go home the same day; some stay overnight.
• You may have bloating, gas, or a sore throat for about a day.
• If a plastic stent was placed, it usually needs to be removed or replaced in a few months.
• If your gallbladder caused the stones, you may be referred to a surgeon to remove it.

Risks

ERCP is generally safe, but it has more risk than a routine endoscopy:

• Pancreatitis (inflammation of the pancreas) in about 3 to 10% of patients, causing belly pain, nausea, and vomiting. Most cases are mild. A medicine suppository (indomethacin), IV fluids, and sometimes a small temporary pancreatic stent are used to lower the risk.
• Bleeding, especially after a sphincterotomy; serious bleeding is uncommon
• Infection of the bile ducts or gallbladder
• Perforation (a tear), which is rare
• Reactions to sedation

Occasionally the procedure cannot be completed and another approach is needed.

Call your doctor or go to the emergency room for severe belly pain, fever or chills, vomiting, black stools, or bleeding after ERCP.

Make an appointment

Our gastroenterologists in Temple City care for patients from Arcadia, San Gabriel, Pasadena, Monrovia, Monterey Park, and across the San Gabriel Valley. We accept most PPO plans (see accepted insurances), and our doctors speak English, Vietnamese, and Mandarin. Schedule an appointment or call 626-898-4560.

This article is for general education and is not a substitute for medical advice. Talk with your doctor about your own health.