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Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure that diagnoses problems in the liver, gallbladder, bile ducts and pancreas. ERCP may be used to discover the causes for jaundice, upper abdominal pain and unexplained weight loss. ERCP combines the use of x-ray and an endoscope (a long, flexible, lighted tube) through which the physician can see the inside of the stomach, duodenum and ducts in the biliary tree and pancreas.

The Procedure

During the procedure, you will be asked to lie on your left side on an examining table in an x-ray room. Medication to help numb the back of the throat, as well as a sedative will be administered to help you relax during the exam.

  • You will swallow the endoscope.
  • The physician will guide the endoscope through your esophagus, stomach and duodenum until it reaches the area where the ducts of the biliary tree and pancreas open into the duodenum.
  • You will be turned to lie flat on your stomach and the physician will pass a small plastic tube through the endoscope to inject a dye into the ducts.
  • A radiographer will begin taking x-rays as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the endoscope to remove or work around the obstruction. Also, a biopsy (collection of tissue samples) may be conducted if further testing is deemed necessary. This procedure takes between 30 minutes and 2 hours.

Preparing for Your Appointment

For the procedure to be accurate and safe, your stomach and duodenum must be completely empty. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on what time your procedure is scheduled. Also, the physician will need to know if you have any allergies, especially to iodine (the dye). You must also arrange for someone to take you home, as you will not be able to drive due to the sedatives administered for the procedure.

After Your Appointment

ERCP is an outpatient procedure. After the exam is completed, you will need to stay for a bit to recover, or until the sedative wears off. Before you leave, the physician will make sure you do not have any signs of complications. Although unlikely, occasionally patients require an overnight hospital stay. If any treatment is done during the ERCP, such as removing a gallstone, an overnight stay is possible.


Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding and perforation of the duodenum. However, such problems are uncommon. You may have tenderness or a lump where the sedative was administered, but that should go away in a few days or weeks.

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