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• ERCP is a diagnostic procedure designed to examine diseases of the liver, bile ducts, and pancreas.
• ERCP is usually best performed under general anesthesia. It may be done using IV sedation.
• There is a low incidence of complications.
• ERCP can provide valuable information that cannot be obtained by other diagnostic examinations, such as abdominal ultrasound, CT scan, or MRI.
• Frequently, therapeutic measures can be performed at the ERCP time to remove stones in the bile ducts or to relieve obstruction of the bile ducts.

What is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic test to examine:
     •  the duodenum (the first portion of the small intestine),
     • the papilla of Vater (a small nipple-like structure with openings leading to the bile ducts and the pancreatic duct),
     • the bile ducts, and
     • the gallbladder and the pancreatic duct.

The procedure is performed by using a long, flexible, viewing instrument (a duodenoscope) about the diameter of a pen. The duodenoscope can be directed and moved around the many bends of the stomach and duodenum. The modern duodenoscope uses a thin fiber-optic bundle to transmit light to the tip of the endoscope. A thin wire with a chip also at the tip of the endoscope to send digital video images to a TV screen. The duodenoscope is inserted through the mouth, through the back of the throat, down the food pipe (esophagus), through the stomach and into the duodenum. Once the papilla of Vater is identified, a small plastic catheter (cannula) is passed through an open channel of the endoscope into the opening of the papilla and the bile ducts and or the pancreatic duct. Contrast material (dye) is injected, and X-rays are taken of the bile ducts and the pancreatic duct. Another open channel in the endoscope also allows other instruments to be passed through it to perform biopsies, to insert plastic or metal stents or tubing to relieve obstruction of the bile ducts or pancreatic duct caused by cancer or scarring and to perform incisions by using electrocautery (electric heat).

The liver is a large solid organ located beneath the right diaphragm. The liver produces bile, stored in the gallbladder (a small sac located beneath the liver). After meals, the gallbladder contracts and empties the bile through the cystic duct, into the bile ducts, through the papilla of Vater, and into the intestine to help with digestion. The pancreas is located behind the stomach. It produces a digestive juice that drains through the pancreatic duct–which usually joins the bile duct within the papilla,–and then enters the intestine.

A vital procedure related to ERCP is endoscopic ultrasonography, which uses a similar endoscope. In addition to the camera, it has an ultrasound probe on its tip to examine the bile ducts gallbladder, pancreatic duct, and pancreas ultrasonographically. Ultrasonographically-directed needle biopsies of the pancreas can be taken through a channel in the endoscope.

A second, newer procedure related to ERCP is the use of miniature endoscopes (Spyglass) that are passed through the operating channel of a duodenoscope and can be inserted directly into the bile and pancreatic ducts. The inside of the ducts can be visualized, and directed biopsies (Spybite) can be taken. Other therapeutic interventions also are possible.


By reading this website, you acknowledge that you are responsible for your own health decisions. The information throughout this medical website is not intended to be taken as medical advice. The information provided is intended for general information regarding gastroenterology conditions and services.

If you are interested in finding out more, avoid worrisome self-diagnosis, please contact a Doral Health & Wellness specialist for a personal consultation. No information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.