Endoscopic Retrograde Cholangiopancreatography (ERCP)

What is an ERCP? 
An ERCP is a procedure used to diagnose and treat problems of the gallbladder, pancreas, liver and biliary tree (the pipes that drain these organs). An ERCP uses a special camera called a duodenoscope – a long, thin flexible tube with a camera and light at the tip – which is passed through the mouth and into the duodenum (first part of the small bowel) where the ampulla is located. This is the point where the biliary tree enters the bowel, draining the liver, gallbladder and pancreas. Instruments can then be passed through the biliary tree into the gallbladder, liver and pancreas as required.

Why do I need an ERCP?
An ERCP can be performed for many reasons. One of the most common reasons for an ERCP are bile duct stones, which are small stones made within the gallbladder (or the biliary tree itself if you have already had your gallbladder removed) and then obstruct the flow of bile at the ampulla.  Symptoms might include sharp pain in the abdomen under your rib cage, vomiting, and indigestion, particularly after a meal. If bile duct stones are not treated, the symptoms will usually get worse.

How is an ERCP performed?
An ERCP is usually performed under a light anaesthetic and is not painful. As a result, you will not be able to drive for 24 hours or operate machinery after the procedure is complete. You will need someone to drive you to and from your procedure. Usually, if you are having your first ERCP, a small cut is made at the ampulla to allow access to the liver, gallbladder and pancreas. The bile duct is then assessed using dye and x-rays, at which time stones in the bile duct can also be removed. Sometimes, if there are a lot of stones or swelling occurs around the ampulla, a stent (like a soft drinking straw) might need to be placed to ensure the liver pipes drain well after the procedure. A small anti-inflammatory suppository is inserted into the rectum to prevent pancreatitis after the procedure.

The length of the ERCP procedure is highly variable, taking between 10 minutes and 2 hours, depending upon what is found.

What are the risks of an ERCP?
ERCP is a very safe procedure, and complications are rare when the procedure is performed by doctors who are specially trained in ERCP. A/Prof Chris Mills is currently the only specialist trained in ERCP in Gippsland.

Very few people experience serious side-effects from ERCP. The most common side effect is bloating. Pancreatitis is the most frequent serious complication and causes pain in the abdomen. It is usually mild and settles at home with pain relief, bowel rest and maintaining a clear fluid diet. However, very rarely pancreatitis can more severe, and has been known to result in death in extreme circumstances. Exceedingly rare complications of ERCP include tearing a small hole in the oesophagus, stomach or small bowel wall (perforation), bleeding, a failure to complete the procedure, an incorrect diagnosis, a missed lesion or complications of the anaesthetic. Please feel free to discuss any of these complications with your specialist if you would like more information prior to your procedure. 

I still have some questions. Where can I go?
For further information, please browse through our Info Section, catch us through our Contact Us page or reach out to our friendly Gippsland Specialist Group staff on (03) 5630 8800.

We also have some other Info Sheets on our website about endoscopic mucosal resection and colonoscopy that might help - please click here.
To download this ERCP Information page as a pdf - please click here.