ERCP (Endoscopic Retrograde Cholangiopancreatography)

The pain started under your right ribs, spread to your back and wouldn't let up. Then your eyes turned yellow, your urine went the colour of strong tea and your stools turned pale. Perhaps you already knew you had gallstones. One of them has probably slipped out of the gallbladder and lodged in the bile duct, the tube that carries bile from the liver to the intestine.

ERCP (endoscopic retrograde cholangiopancreatography) clears that blockage from the inside. Under deep sedation, a gastroenterologist passes a side-viewing endoscope through your mouth and stomach into the duodenum, where the bile duct opens at a small nipple called the papilla. A thin tube is passed up into the duct, dye is injected, and X-rays show the stones or narrowing. The opening of the duct is then widened with a small cut (sphincterotomy) and the stones are pulled out, or a small tube called a stent is left to keep bile flowing.

When stones are the cause, ERCP clears the duct in most people in one sitting, and the jaundice starts to fade within days. ERCP is a treatment rather than a first test. If the only question is whether there's a stone, an MRCP scan or an endoscopic ultrasound usually comes first, because ERCP carries a real risk of pancreatitis.

ERCP for bile duct stones and pancreatic conditions is one of the therapeutic procedures our gastroenterology department performs, with sedation and monitoring throughout. If you still have stones in the gallbladder, we'll usually plan its removal by laparoscopic cholecystectomy with the surgical team, since otherwise stones tend to come back.

ERCP is for problems in the bile or pancreatic ducts that need treating through the scope.

Most people stay one night so the team can watch for pancreatitis, which usually shows itself within the first few hours.