Duke’s nationally recognized experts offer particular expertise in endoscopic retrograde cholangiopancreatography (ERCP), which is used to provide the most accurate diagnosis for patients who may have problems in the liver, gallbladder, bile ducts, or pancreas. Duke performs a large volume of these procedures each year.

The procedure combines the use of x-rays and an endoscope, which is a long, flexible, lighted tube. Through it, the physician can see the inside of the stomach and duodenum, and from there inject dyes into the ducts of the biliary tree and pancreas so they are visible on x-rays.

ERCP is used primarily to diagnose and treat conditions of the bile ducts including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer.

The full name, endoscopic retrograde cholangiopancreatography, is pronounced en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee.

During the Procedure

The patient will lie on his or her left side on an examining table in an x-ray room. The patient will be given medication to help numb the back of their throat and a sedative to help them relax during the exam. He or she will then swallow the endoscope, and the physician will guide the scope through their esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum.

At this time, the patient will be turned to lie flat on their stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to illuminate them on the x-rays. X-rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. The patient may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

The ERCP procedure can take from 30 minutes to two hours to complete. The patient may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should minimize the discomfort.

After the procedure, the patient will need to stay at the hospital for one to two hours until the sedative wears off. The physician will make sure the patient does not have any signs of complication before they leave. If any kind of treatment is done during ERCP, such as the removal of a gallstone, the patient may need to stay in the hospital overnight.

Appointments

For more information or to schedule an appointment, call 919-684-6437.

Information for referring physicians can be found on the Appointments and Referrals page.

Physicians

Physicians offering this service include:

• Abdelmalek, Manal F.
  • Medicine / Medicine - Gastroenterology
• Brady, Carla W.
  • Medicine / Medicine - Gastroenterology
• Branch, M. Stanley
  • Medicine / Medicine - Gastroenterology
• Diehl, Anna Mae E.
  • Medicine / Medicine - Gastroenterology
• Haque, Mahfuzul
  • Medicine / Medicine - Gastroenterology
• Jowell, Paul S.
  • Medicine / Medicine - Gastroenterology
• Muir, Andrew J.
  • Medicine / Medicine - Gastroenterology
• Obando, Jorge V.
  • Medicine / Medicine - Gastroenterology
• Smith, Alastair D.
  • Medicine / Medicine - Gastroenterology

Locations

This service is available at:

• Duke Gastroenterology
  Duke Clinic 2G/2H, 200 Trent Drive, Durham, NC 27710
• Duke Raleigh Hospital
  3400 Wake Forest Road, Raleigh, NC 27609