Endoscopic retrograde cholangiopancreatography, or ERCP, is a study of the ducts that drain the liver and pancreas. Ducts are drainage route into the bowel. The ones that drain the liver and gallbladder are called bile or biliary ducts. The one that drains the pancreas is called the pancreatic duct. The bile and pancreatic ducts join together just before they drain into the upper bowel, about 3 inches from the stomach. The drainage opening is called the papilla. The papilla is surrounded by a circular muscle, called the sphincter of Oddi. Diagnostic ERCP is when X-ray contrast dye is injected into the bile duct, the pancreatic duct, or both. This contrast dye is squirted through a small tube called a catheter that fits through the ERCP endoscope. X-rays are taken during ERCP to get pictures of these ducts. That is called diagnostic ERCP. However, most ERCPs are actually done for treatment and not just picture taking. When an ERCP is done to allow treatment, it is called therapeutic ERCP.

Need for ERCP
ERCP is used for stone removal, for stent placement, etc. Refer to the facts below:

Sphincterotomy
Sphincterotomy is cutting the muscle that surrounds the opening of the ducts, or the papilla. This cut is made to enlarge the opening. The cut is made while your doctor looks through the ERCP scope at the papilla, or duct opening.

Stone Removal
The most common treatment through an ERCP scope is removal of bile duct stones. These stones may have formed in the gallbladder and traveled into the bile duct or may form in the duct itself years after your gallbladder has been removed.

Stent Placement
Stents are placed into the bile or pancreatic ducts to bypass strictures, or narrowed parts of the duct. These narrowed areas of the bile or pancreatic duct are due to scar tissue or tumors that cause blockage of normal duct drainage. There are two types of stents that are commonly used. Both plastic and metal stents tend to clog up after several months and you may require ERCP for the first time and then another ERCP to place a new stent.

Balloon Dilation
There are ERCP catheters fitted with dilating balloons that can be placed across a narrowed area or stricture. The balloon is then inflated to stretch out the narrowing. Dilation with balloons is often performed when the cause of the narrowing is benign (not a cancer).

Tissue Sampling
One procedure that is commonly performed through the ERCP scope is to take samples of tissue from the papilla or from the bile or pancreatic ducts. Tissue samples can help decide if a stricture, or narrowing, is due to a cancer.

ERCP is not painful
ERCP will be used to examine the lining of your stomach and duodenum. Though you’ll not feel any pain, but you may have a sense of fullness, as air may be introduced to carry on the procedure.

It is safe to go for ERCP
The overall ERCP complication rate causing any emergency or requiring hospitalization is 6-10%. The most common complication is pancreatitis, or inflammation of the pancreas. Other complications include bleeding, infection, an adverse reaction to the sedative medication, or bowel perforation. Most complications are managed without surgery but may require you to stay in the hospital for treatment.

Prior to having ERCP, there are a number of things you will need to remember:

• Do not consume any solid or liquid for at least six hours.
• It is a common saying that, “Never hide anything from your doctor.” So, let the physician know about any medication you are following.
• Inform about any allergic reactions to drugs, etc.