ERCP
ERCP (Endoscopic Retrograde Cholangiopancreatography) combines endoscopy and X-ray imaging to diagnose and treat problems affecting the bile ducts and pancreatic duct. A flexible endoscope is passed through the mouth to the first part of the small intestine, and a thin tube is inserted into the bile duct opening. Contrast dye is injected and X-rays are taken. Therapeutic interventions — removing bile duct stones, placing stents to relieve obstructions, or cutting the bile duct opening (sphincterotomy) — are performed in the same session.
🔬 How the Procedure Is Performed
- 1
The patient receives IV sedation and lies on an X-ray table.
- 2
A side-viewing duodenoscope is passed to the duodenum.
- 3
The bile duct opening (papilla of Vater) is identified and cannulated.
- 4
Contrast dye is injected and fluoroscopic X-rays map the bile and pancreatic ducts.
- 5
Sphincterotomy is made if needed to widen the bile duct opening.
- 6
Stones are extracted with a balloon or basket; stents are placed for strictures.
✅ Benefits of ERCP
- ✓Removes bile duct stones without the need for open surgery
- ✓Relieves jaundice caused by bile duct obstruction
- ✓Places stents in bile duct strictures from cancer or injury
- ✓Diagnostic: detects PSC (primary sclerosing cholangitis) and pancreatic duct strictures
- ✓Day or overnight procedure — much less invasive than open bile duct surgery
📋 How to Prepare
- Fast from midnight before the procedure.
- Blood tests including liver function and clotting studies.
- Inform the doctor of any allergy to iodine contrast.
- Blood thinners may need to be stopped.
- Arrange for a responsible adult to take you home.
⚠️ Possible Risks & Side Effects
- Pancreatitis (inflammation of the pancreas) — the most common complication (3–5%)
- Bleeding after sphincterotomy
- Bile duct infection (cholangitis)
- Perforation — rare with experienced hands
- Contrast dye allergy
Your surgeon will discuss all risks with you before the procedure and take appropriate precautions to minimise them.
💊 Post-Procedure Care
- Observation in hospital for 4–24 hours after the procedure.
- Watch for signs of pancreatitis: increasing abdominal pain after the procedure.
- Start with a clear liquid diet and progress as tolerated.
- Report fever or worsening pain immediately.
- If a stent was placed, a follow-up procedure to remove or replace it is scheduled.
❓ Frequently Asked Questions
Do I need ERCP or surgery for a bile duct stone?
ERCP is the preferred approach for most bile duct stones — it avoids the need for open surgery. After ERCP, the gallbladder is usually removed laparoscopically to prevent future stones.
What is the risk of pancreatitis after ERCP?
About 3–5% of patients develop mild pancreatitis after ERCP. Severe pancreatitis is rare (~0.5%). Your doctor will monitor you closely for several hours afterwards.
🏥 ERCP at Iswarya Hospital
Led by Prof. Dr. G. Manoharan, one of India's most distinguished Surgical Gastroenterologists and Liver Transplant Specialists, specializing in advanced surgeries for gastrointestinal, liver, pancreatic, and biliary disorders.
ℹ️ This information is for educational purposes only and does not constitute medical advice. Individual treatment plans may vary. Always consult a qualified healthcare professional before making any medical decisions.