ERCP (Endoscopic Retrograde 

Cholangiopancreatography) 

National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is ERCP? 

Endoscopic retrograde cholangiopancreatography is a procedure that combines upper 

gastrointestinal (GI) endoscopy and x rays 

to treat problems of the bile and pancreatic 

ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests 

such as magnetic resonance cholangiography 

has allowed ERCP to be used primarily for 

cases in which it is expected that treatment 

will be delivered during the procedure; see 

“How is ERCP performed?” 

What is upper gastrointestinal 

(GI) endoscopy? 

Upper GI endoscopy is a procedure that uses 

a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. 

The upper GI tract includes the esophagus, 

stomach, and duodenum—the first part of 

the small intestine. 

Common 

bile duct 

Esophagus 

Liver 

Stomach 

Main 

pancreatic 

duct 

Pancreas 

Small intestine Large intestine 

Duodenum 

Gallbladder 

The bile ducts carry bile from the liver to the 

duodenum. The pancreatic ducts carry pancreatic 

juice from the pancreas to the duodenum. 
 

 

 

2 ERCP (Endoscopic Retrograde Cholangiopancreatography) 

What are the bile and 

pancreatic ducts? 

Ducts are tubelike structures in the body 

that carry fluids. The bile ducts carry bile, 

a liquid the liver makes to help break down 

food. A group of small bile ducts—called the 

biliary tree—in the liver empties bile into the 

larger common bile duct. Between meals, 

the common bile duct closes and bile collects 

in the gallbladder—a pear-shaped sac next to 

the liver. 

The pancreatic ducts carry pancreatic juice, 

a liquid the pancreas makes to help break 

down food. A group of small pancreatic 

ducts in the pancreas empties into the main 

pancreatic duct. 

The common bile duct and the main pancreatic duct join before emptying their contents 

into the duodenum through the papillary 

orifice at the end of the duodenal papilla—a 

small, nipplelike structure that extends into 

the duodenum.

Duodenal papilla 

Papillary orifice 

Liver Biliary tree 

(bile ducts) 

Common bile duct 

Pancreas 

Duodenum Main pancreatic duct

Duodenal 

papilla 

Gallbladder 

The common bile duct and the main pancreatic duct join before emptying their contents into the duodenum 

through the papillary orifice at the end of the duodenal papilla—a small, nipplelike structure that extends into 

the duodenum. 
 

When is ERCP used? 

ERCP is used when it is suspected a person’s 

bile or pancreatic ducts may be narrowed or 

blocked due to 

• tumors 

• gallstones that form in the gallbladder 

and become stuck in the ducts 

• inflammation due to trauma or illness, 

such as pancreatitis—inflammation of 

the pancreas 

• infection 

• valves in the ducts, called sphincters, 

that won’t open properly 

• scarring of the ducts, called sclerosis 

• pseudocysts—accumulations of fluid 

and tissue debris 

How does a person prepare 

for ERCP? 

The health care provider usually provides 

written instructions about how to prepare for 

ERCP. 

The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours 

before ERCP. Smoking and chewing gum 

are also prohibited during this time. 

Patients should tell their health care provider about all health conditions they have, 

especially heart and lung problems, diabetes, 

and allergies. Patients should also tell their 

health care provider about all medications 

they take. Patients may be asked to temporarily stop taking medications that affect 

blood clotting or interact with sedatives, 

which are usually given during ERCP to help 

patients relax and stay comfortable. 

Medications and vitamins that may be 

restricted before and after ERCP include 

• nonsteroidal anti-inflammatory drugs, 

such as aspirin, ibuprofen (Advil), and 

naproxen (Aleve) 

• blood thinners 

• high blood pressure medication 

• diabetes medications 

• antidepressants 

• dietary supplements 

Driving is not permitted for 12 to 24 hours 

after ERCP to allow the sedatives time to 

completely wear off. Before the appointment, patients should make plans for a ride 

home. 

3 ERCP (Endoscopic Retrograde Cholangiopancreatography) 
 

How is ERCP performed? 

ERCP is conducted at a hospital or outpatient center by a doctor and assistants who 

have specialized training in this procedure. 

Patients receive a local anesthetic that is 

gargled or sprayed on the back of the throat. 

The anesthetic numbs the throat and calms 

the gag reflex. 

An intravenous needle is inserted into a vein 

in the arm if sedatives will be given. Doctors 

and other medical staff monitor vital signs 

while patients are sedated. 

During ERCP, patients lie on their back or 

side on an x-ray table. The doctor inserts an 

endoscope down the esophagus, through the 

stomach, and into the duodenum. Video is 

transmitted from a small camera attached to 

the endoscope to a computer screen within 

the doctor’s view. Air is pumped through the 

endoscope to inflate the stomach and duodenum, making them easier for the doctor to 

examine. 

When the doctor locates the duodenal 

papilla, a blunt tube called a catheter is slid 

through the endoscope and guided through 

the papillary opening. Once the catheter is 

inside the papilla, the doctor injects a dye 

into the ducts. The dye, also called contrast 

medium, allows the ducts to be seen on 

x rays. X rays are then taken to see the ducts 

and to look for narrowed areas or blockages. 

Procedures to treat narrowed areas or blockages can be performed during ERCP. To see 

the ducts during treatment procedures, the 

doctor uses x-ray video, also called fluoroscopy. Special tools guided through the endoscope and into the ducts allow the doctor 

to open blocked ducts, break up or remove 

gallstones, remove tumors in the ducts, or 

insert stents. Stents are plastic or expandable metal tubes that are left in narrowed 

ducts to restore the flow of bile or pancreatic 

juice. A kind of biopsy called brush cytology 

allows the doctor to remove cells from inside 

the ducts using a brush that fits through the 

endoscope. The collected cells are later 

examined with a microscope for signs of 

infection or cancer. 

Occasionally, ERCP is done after gallbladder 

surgery, if a surgical bile leak is suspected, to 

find and stop the leak with a temporary stent. 

4 ERCP (Endoscopic Retrograde Cholangiopancreatography) 
 

What does recovery from 

ERCP involve? 

After ERCP, patients are moved to a recovery room where they wait for about an hour 

for the sedatives to wear off. Patients may 

not remember conversations with health 

care staff, as the sedatives reduce memory 

of events during and after the procedure. 

During this time, patients may feel bloated 

or nauseous. Patients may also have a sore 

throat, which can last a day or two. 

Patients can go home after the sedatives 

wear off. Patients will likely feel tired and 

should plan to rest for the remainder of the 

day. 

Some ERCP results are available immediately after the procedure. Biopsy results are 

usually ready in a few days. 

Eating, Diet, and Nutrition 

Unless otherwise directed, patients may 

immediately resume their normal diet and 

medications after having an ERCP. The 

health care provider can answer any specific 

questions about eating, diet, and nutrition. 

What are the risks 

associated with ERCP? 

Significant risks associated with ERCP 

include 

• infection 

• pancreatitis 

• allergic reaction to sedatives 

• excessive bleeding, called hemorrhage 

• puncture of the GI tract or ducts 

• tissue damage from radiation exposure 

• death, in rare circumstances 

When ERCP is performed by an experienced doctor, complications occur in about 

6 to 10 percent of patients and these often 

require hospitalization.1 Patients who 

experience any of the following symptoms 

after ERCP should contact their health care 

provider immediately: 

• swallowing difficulties 

• throat, chest, or abdominal pain that 

worsens 

• vomiting 

• bloody or dark stool 

• fever 

1Andruilli A, Loperfido S, Napolitano G, et al. 

Incidence rates of post-ERCP complications: a 

systematic survey of prospective studies. American 

Journal of Gastroenterology. 2007;102:1781–1788. 

5 ERCP (Endoscopic Retrograde Cholangiopancreatography) 
 

Points to Remember 

• ERCP is a procedure that combines 

upper gastrointestinal (GI) endoscopy 

and x rays to treat problems of the bile 

and pancreatic ducts. 

• Upper GI endoscopy is a procedure 

that uses a lighted, flexible endoscope to 

see and perform procedures inside the 

upper GI tract. 

• Ducts are tubelike structures in the 

body that carry fluids. The bile ducts 

carry bile, a liquid the liver makes to 

help break down food. The pancreatic 

ducts carry pancreatic juice, a liquid 

the pancreas makes to help break down 

food. 

• The common bile duct and the main 

pancreatic duct join before emptying 

their contents into the duodenum, the 

first part of the small intestine. 

• The health care provider usually provides written instructions about how to 

prepare for ERCP. 

• Driving is not permitted for 12 to 

24 hours after ERCP to allow the 

sedatives time to completely wear off. 

Before the appointment, patients should 

make plans for a ride home. 

• During ERCP, the doctor inserts 

an endoscope down the esophagus, 

through the stomach, and into the 

duodenum. 

• The doctor injects contrast medium into 

the ducts and x rays are taken to see the 

ducts. 

• Special tools that slide through the 

endoscope allow the doctor to open 

blocked ducts, break up or remove 

gallstones, remove tumors in the ducts, 

or insert stents. 

• Significant risks associated with ERCP 

include infection, pancreatitis, allergic 

reaction to sedatives, excessive bleeding, 

puncture of the GI tract or ducts, tissue 

damage from radiation exposure, and, 

in rare circumstances, death. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

conducts and supports basic and clinical 

research into many digestive disorders. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

6 ERCP (Endoscopic Retrograde Cholangiopancreatography) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For More Information 

Fact sheets about other diagnostic tests 

are available from the National Digestive 

Diseases Information Clearinghouse at 

www.digestive.niddk.nih.gov, including 

• Colonoscopy 

• Flexible Sigmoidoscopy 

• Liver Biopsy 

• Lower GI Series 

• Upper GI Endoscopy 

• Upper GI Series 

• Virtual Colonoscopy 

American College of Gastroenterology 

6400 Goldsboro Road, Suite 450 

Bethesda, MD 20817–5846 

Phone: 301–263–9000 

Email: info@acg.gi.org 

Internet: www.acg.gi.org 

American Gastroenterological Association 

4930 Del Ray Avenue 

Bethesda, MD 20814 

Phone: 301–654–2055 

Fax: 301–654–5920 

Email: member@gastro.org 

Internet: www.gastro.org 

American Society for Gastrointestinal 

Endoscopy 

1520 Kensington Road, Suite 202 

Oak Brook, IL 60523 

Phone: 1–866–353–ASGE (1–866–353–2743)

 or 630–573–0600 

Fax: 630–573–0691 

Email: info@asge.org 

Internet: www.asge.org 

Society of American Gastrointestinal and 

Endoscopic Surgeons 

11300 West Olympic Boulevard, Suite 600 

Los Angeles, CA 90064 

Phone: 310–437–0544 

Fax: 310–437–0585 

Email: webmaster@sages.org 

Internet: www.sages.org 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK 

scientists and outside experts. This publication was reviewed by Isaac Samuel, M.D., 

F.R.C.S., F.A.C.S., Associate Professor of 

Surgery, Carver College of Medicine, University of Iowa. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

This publication may contain information about 

medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration tollfree at 1–888–INFO–FDA (1–888–463–6332) or visit 

www.fda.gov. Consult your health care provider for 

more information. 

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

7 ERCP (Endoscopic Retrograde Cholangiopancreatography) 
 

 

 

 

 

National Digestive Diseases 

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Phone: 1–800–891–5389 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov 

The National Digestive Diseases Information 

Clearinghouse (NDDIC) is a service of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The 

NIDDK is part of the National Institutes of 

Health of the U.S. Department of Health 

and Human Services. Established in 1980, 

the Clearinghouse provides information 

about digestive diseases to people with 

digestive disorders and to their families, 

health care professionals, and the public. 

The NDDIC answers inquiries, develops and 

distributes publications, and works closely 

with professional and patient organizations 

and Government agencies to coordinate 

resources about digestive diseases. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and 

distribute as many copies as desired. 

This publication is available at 

www.digestive.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 12–4336 

December 2011 

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