Endoscopic retrograde cholangiopancreatography (ERCP) is a test used to diagnose and treat conditions of the liver, gallbladder, bile ducts, pancreas and pancreatic duct.
This procedure uses a flexible tube with a light and camera plus X-rays to look for problems in the bile and pancreatic ducts. While your child is asleep, an endoscope is passed through the mouth, down the esophagus, into the stomach and then into the small intestine. A small opening in the small intestine called the ampulla of Vater gives access to the bile duct.
The doctor can inject a dye into the bile duct. When X-rays are taken during the ERCP, the dye will show the location of any blockages, narrow ducts, irregularities or stones.
ERCP is a diagnostic and therapeutic procedure that takes between 45 and 90 minutes to complete.
The procedure is used to diagnose and monitor several conditions and symptoms, including:
- Abdominal pain
- Autoimmune hepatitis
- Enlarged liver
- Enlarged spleen
- Sclerosing cholangitis
The doctor can also perform certain treatments during an ERCP. Small instruments are passed through the scope to complete procedures such as:
- Stone removal. If a stone is stuck in the bile duct, the doctor can use balloons and baskets to pull the stone out. If a stone is too large to be removed, it can be crushed into small pieces before it is taken out. This is a biliary intervention procedure called mechanical lithotripsy.
- Sphincterotomy. To make more room for stone removal or other treatments, the doctor may need to cut the muscles at the openings of the bile duct or pancreatic duct. A small incision is used to expand the opening.
- Stent placement. Damaged bile ducts can be held open with a small plastic or metal tube called a stent. The doctor can place a stent inside a duct after it is widened or a stone is removed.
- Treatment of bile duct blockages. Benign or malignant blockages and tumors in the bile ducts can be monitored and treated with medicines and stenting.
- Management of sphincter of Oddi dysfunction. This round muscle controls the flow of bile and pancreatic liquid into the small intestine to aid in digestion. When the sphincter does not open or close properly, the digestive fluids leak or back up, causing severe abdominal pain. Medicines can help treat this condition. Sometimes a sphincterotomy is needed.
ERCP at Riley at IU Health is performed by adult gastroenterologists with help from pediatric specialists. This is because ERCP is done infrequently in children, while adult gastroenterologists and endoscopists perform thousands of ERCP procedures each year. Sometimes a smaller infant scope is used in children who need ERCP.
What to Expect
What to Expect
On the day before the ERCP procedure:
- Your child should not eat anything or drink any milk, milk products, formula or juices with pulp after midnight.
On the day of the ERCP procedure:
- Your child should not eat anything the morning of the test. His or her stomach needs to be empty for an ERCP test.
- Your child can drink clear liquids up to three hours before the test if he or she is older than 6 months and up to two hours before the test if he or she is younger than 6 months.
- When you arrive at the hospital or outpatient center, you and your child will meet with the doctor.
- The gastroenterologist will talk with you and your child to answer your questions and discuss the ERCP test.
- Your child will change into a hospital gown.
- He or she will be taken to an operating room or an endoscopy suite.
- An intravenous (IV) line will be started to administer anesthesia. General anesthesia will be given to your child through the IV so that he or she falls asleep and does not feel any pain.
- A numbing medicine will be sprayed into the mouth to make the test more comfortable.
- Your child’s heart rate, blood pressure, respiratory rate and oxygen level will be monitored during the procedure.
- A mouth guard may be placed in your child’s mouth to prevent biting down on the endoscope and to protect the teeth.
- Once your child is asleep, the endoscope will be passed through the mouth, down the esophagus, into the stomach and then into the small intestine.
- The doctor will move the endoscope until he finds the ampulla of Vater inside the small intestine. This is the opening of the common bile duct and pancreatic duct.
- The common bile duct branches off into many small ducts from this site.
- The doctor will inject a small amount of contrasting dye into the ducts.
- The dye will show up on the X-ray monitors, allowing the doctor to see stones and other areas of blockage or damage.
- If stones are found, the doctor can remove them.
- Tiny muscles called sphincters may need to be cut to widen the duct and make more room for stone removal.
- The doctor will use tiny balloons and a basket to sweep out the duct and capture the stones.
- If the stones are large, the doctor might first break them apart with a laser or metal plate.
- If the doctor finds a duct that is too narrow for bile to pass through, the space can be opened.
- The doctor will pass a small balloon into the duct and inflate it. This pressure causes the narrow duct to open up.
- A stent is then placed into the widened duct to keep it open.
- If your child has recurring pancreatitis, the doctor can treat the condition by stenting narrowed areas of the pancreatic duct.
- If there is a tear in the pancreatic duct that is causing fluid leakage, a stent can be used to help close and repair the tear.
- When the doctor is done examining and treating the ducts, the endoscope and mouth guard are removed.
Immediately after the ERCP procedure:
- Your child will be moved to a recovery room to wake up. You can be with him or her during this time.
- Your child’s vital signs will be monitored.
- When your child wakes up, nurses will continue to check blood pressure, pulse and breathing rates until they return to normal.
- After your child is fully awake, liquids will be given to drink.
- Most children are able to drink two hours after the ERCP.
- Most children can eat something an hour or two after the procedure.
- The doctor will discuss what was seen during the exam and may have photos to show you.
- The doctor may recommend medicines for your child to take.
- Once your child is able to drink normally, he or she will be allowed to go home.
- Some children may feel sick after the test and will be watched for a longer amount of time.
- The total time spent at the hospital will depend on the testing and the time for your child to wake up.
- It is best to expect to spend between three and four hours at the hospital.
Once you and your child return home, you should follow these guidelines:
- Your child may have a sore throat for a few days after the ERCP. This is normal.
- You should call the doctor if your child shows any of these symptoms after an ERCP:
- Abdominal pain
- Black, tarry or bloody stools
- Fever and/or chills
- Redness, swelling, bleeding or drainage from the IV site
- Swallowing problems
- Throat or chest pain that worsens
Key Points to Remember
Key Points to Remember
- ERCP is used to diagnose and treat conditions of the liver, gallbladder, bile ducts, pancreas and pancreatic duct.
- ERCP combines endoscopy and X-ray technology to locate blockages, narrow ducts, irregularities and stones.
- ERCP takes between 45 and 90 minutes to complete.
- ERCP at Riley at IU Health is performed by adult gastroenterologists and endoscopists who complete thousands of ERCP procedures each year.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.