What is ERCP?
ERCP (Endoscopic Retrograde Cholangiopancreatography) is a specialised endoscopic procedure that combines endoscopy and fluoroscopy (real-time X-ray) to diagnose and treat problems in the bile duct and pancreatic duct. It is both diagnostic (seeing the ductal anatomy) and therapeutic (treating the problem in the same session).
At Dhaara Speciality Hospital, ERCP is performed by Dr. Srinivas Bojanapu, an experienced surgical gastroenterologist with expertise in advanced endoscopic procedures. The procedure is performed under IV sedation — patients are comfortable and have no memory of the procedure.
When is ERCP Recommended?
Bile Duct Conditions
- CBD stones (common bile duct stones)
- Bile duct strictures (narrowing)
- Primary sclerosing cholangitis (PSC)
- Bile leak after surgery
- Jaundice from bile duct obstruction
- Cholangiocarcinoma (bile duct cancer) — for stenting
Pancreatic Conditions
- Pancreatic duct stones
- Pancreatic duct strictures
- Chronic pancreatitis with duct obstruction
- Pancreatic pseudocyst drainage
- Pancreatic fistula
- Ampullary tumours
What Happens During ERCP?
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Step 1IV sedation + throat anaesthetic spray
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Step 2Side-viewing duodenoscope passed to duodenum
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Step 3Contrast dye injected; X-ray imaging (fluoroscopy)
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Step 4Therapeutic intervention (stones, stents, sphincterotomy)
Therapeutic Interventions During ERCP
Sphincterotomy (EST — Endoscopic Sphincterotomy): A small cut is made in the sphincter of Oddi (the muscular valve at the bile duct opening) to widen it. This allows stones to pass or instruments to be introduced.
Stone Extraction: CBD stones are captured using a retrieval balloon or Dormia basket and pulled out through the sphincterotomy. Balloon sphincteroplasty (balloon dilation) used for large stones or when anatomy is altered.
Stent Placement (Biliary Stenting): Plastic or metal stent placed across a stricture or tumour to restore bile flow and relieve jaundice. Metal stents (SEMS) are self-expanding for long-term palliation.
Pancreatic Stenting: Plastic stent placed in the pancreatic duct to relieve obstruction from strictures or stones, and to treat post-ERCP pancreatitis prophylactically.
Lithotripsy: Mechanical or electrohydraulic fragmentation of large stones that cannot be extracted intact.
Tissue Sampling (Brush Cytology / Biopsy): Tissue sampled from suspicious strictures to confirm or exclude malignancy.
Preparing for ERCP
- Fasting: Nothing to eat or drink for at least 6 hours before the procedure
- Medications: Blood thinners (aspirin, clopidogrel, warfarin) may need to be paused — discuss with your doctor
- Allergies: Inform about contrast dye or iodine allergy
- Escort: You will need someone to drive you home — sedation lasts several hours
- Duration: Procedure takes 30–90 minutes; recovery 2–3 hours
Recovery and What to Expect
- Mild throat discomfort and bloating — normal, resolves in a few hours
- Return home same day in most cases
- Light diet for 24 hours; normal diet next day
- Resume normal activities within 24–48 hours
Risks of ERCP
ERCP is a safe procedure in expert hands, but has a small risk of complications:
- Post-ERCP pancreatitis (3–5%): Most common complication — managed with IV fluids and fasting
- Bleeding (1–2%): From sphincterotomy site — usually controllable endoscopically
- Cholangitis (1–2%): Infection of bile duct — treated with antibiotics
- Perforation (<1%): Rare, may require surgical repair
Frequently Asked Questions
Is ERCP painful?
The procedure is performed under IV sedation — you are in a twilight state with no awareness or pain during the procedure. Mild bloating or throat discomfort may be felt after the sedation wears off, but most patients have no memory of the procedure and describe it as comfortable.
How long does ERCP take?
The procedure itself takes 30–90 minutes depending on complexity. You will be in the hospital for 4–6 hours total including preparation and recovery. Most patients go home the same day.
What is the difference between ERCP and MRCP?
MRCP (MR Cholangiopancreatography) is a non-invasive MRI scan that shows the biliary and pancreatic ducts. It is purely diagnostic — no treatment can be done. ERCP involves a scope passed through the mouth, is invasive, but allows treatment (stone removal, stenting) in the same session. MRCP is typically done first; ERCP is reserved for when treatment is needed.