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How Is ERCP Performed?

After administering sedation, the doctor inserts an endoscope—a thin, flexible, lighted tube—down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts.

The doctor guides the endoscope and injects a special dye into the pancreatic or bile ducts that helps the pancreas, gallbladder, and bile ducts appear on the screen while X-rays are taken. This is very helpful to evaluate for any abnormalities that could be causing pancreatitis, including stones in the bile and/or pancreatic duct, or strictures in the bile and/or pancreatic duct. If abnormalities are identified, we can perform appropriate treatments or diagnostic tests while the patient remains under anesthesia.

Procedures performed using ERCP

• Sphincterotomy: Using a small wire on the endoscope, the doctor finds the muscle that surrounds the pancreatic duct or bile ducts and makes a tiny cut to enlarge the duct opening. When a pseudocyst is present, the duct is drained.
• Gallstone removal: The endoscope is used to remove pancreatic or bile duct stones with a tiny basket. Gallstone removal is sometimes performed along with a sphincterotomy.
• Stent placement: Using the endoscope, the doctor places a tiny piece of plastic or metal that looks like a straw in a narrowed pancreatic or bile duct to keep it open.
• Balloon dilatation: Some endoscopes have a small balloon that the doctor uses to dilate, or stretch, a narrowed pancreatic or bile duct. A temporary stent may be placed for a few months to keep the duct open.