Last Updated on October 19, 2025 by Analgesia team
ERCP procedure
What it does
ERCP is a procedure that uses an endoscope, a long, flexible, lighted tube, to examine the bile and pancreatic ducts. It combines X-rays and a camera to provide images of these ducts. A dye may be injected through the scope to highlight the organs on an X-ray.
What is it used for
ERCP can be used to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It can help find the cause of unexplained abdominal pain or yellowing of the skin and eyes (jaundice). It can also be used to evaluate stones, tumours, or narrowed areas of the ducts.
How it’s performed
An endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that involves passing a camera-equipped tube through the mouth and into the small intestine. This allows a doctor to examine the liver, gallbladder, bile ducts, and pancreas.
Who benefits most from ERCP?
ERCP is especially useful for patients with problems in the bile or pancreatic ducts. Typical candidates include those with:
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Gallstones or bile duct stones cause pain, jaundice, or infection
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Narrowing (strictures) of the bile or pancreatic ducts due to scarring, tumors, or inflammation
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Chronic pancreatitis requiring drainage or stent placement
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Unexplained jaundice where imaging has identified a blockage in the ducts
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Patients needing tissue sampling (biopsy) from the bile or pancreatic ducts to check for cancer or other conditions
Because ERCP is both diagnostic and therapeutic, it is often preferred over surgery for these conditions, minimising recovery time and risks.
ERCP step-by-step procedure
ERCP is a minimally invasive procedure that combines endoscopy and imaging to diagnose and treat bile and pancreatic duct disorders. Here’s how it typically works:
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Throat numbing: A local anaesthetic spray is applied to the back of the throat to reduce discomfort when the endoscope is passed.
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Sedation: A sedative or light anaesthesia is administered intravenously to help the patient relax and stay comfortable throughout the procedure.
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Endoscope insertion: A thin, flexible tube called an endoscope is gently passed through the mouth, down the throat, through the oesophagus and stomach, and into the duodenum (the first part of the small intestine).
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Dye injection: A contrast dye is injected into the bile and pancreatic ducts through a small catheter inserted via the endoscope. The dye highlights the ducts on X-ray images.
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X-ray imaging: Fluoroscopy (real-time X-rays) is used to confirm the position of the endoscope and the distribution of the dye, allowing doctors to identify blockages, stones, strictures, or other abnormalities.
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Treatment if needed: Depending on what the X-rays reveal, the doctor may remove stones, insert stents, dilate narrow ducts, or take tissue samples during the same procedure, avoiding the need for additional surgery.
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Recovery: After the procedure, patients are monitored while the sedative wears off. Most can return home the same day with guidance on diet, activity, and signs of complications.
Advantages of ERCP
Endoscopic retrograde cholangiopancreatography (ERCP) offers several key benefits for patients with bile or pancreatic duct problems:
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Combines diagnosis and treatment in a single procedure: ERCP allows doctors to both identify blockages, strictures, or stones and perform interventions such as stone removal, stent placement, or tissue sampling without needing separate procedures.
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Minimally invasive compared to surgery: Unlike open surgery, ERCP is performed through the mouth using an endoscope, reducing recovery time, lowering the risk of complications, and often allowing patients to go home the same day or after a short hospital stay.