ERCP (Endoscopic Retrograde Cholangiopancreatography)
Overview
ERCP is the most complex routine endoscopy. The doctor passes a side-viewing scope through your mouth, stomach, and into the duodenum. They identify the small opening (ampulla) where bile and pancreatic ducts drain, then thread thin instruments INTO those ducts. Contrast dye is injected and X-ray fluoroscopy guides the procedure. ERCP can: remove bile duct stones, place stents to open blockages, take biopsies of the bile duct, and treat leaks.
Who needs it
Bile duct stones (choledocholithiasis)
Cholangitis (bile duct infection)
Bile duct strictures (from cancer, surgery, or PSC)
Bile leak after gallbladder surgery or liver transplant
Pancreatic duct stones or strictures
Risks
Post-ERCP pancreatitis: 3-10% (most mild; rare severe cases)
Bleeding after sphincterotomy: 1-2%
Perforation: <1%
Cholangitis if stent placement fails to drain
Sedation/anesthesia reactions: rare
Before the procedure
Fasting for 6-8 hours.
Stop blood thinners as directed (often need 5-7 days).
IV antibiotics may be given.
Remove dentures, contact lenses.
Arrange overnight admission for some patients (longer procedures, complex cases).
When to See a Doctor
Call your doctor or go to emergency if after the procedure you have severe or worsening abdominal pain, fever, repeated vomiting, heavy bleeding, black stools or fainting.
Why it is done
To remove stones from the bile duct, treat cholangitis (bile duct infection), open blockages from cancer or stricture (with stents), assess and treat post-surgical bile leaks, and biopsy suspected bile duct cancers.
During the procedure
General anesthesia or deep sedation is given. You lie on your stomach or left side. The procedure takes 30-60 minutes — sometimes longer for complex cases. The doctor advances the scope to the duodenum, identifies the ampulla, and uses fluoroscopy (live X-ray) to guide instruments into the bile or pancreatic duct. Stones are extracted with balloons or baskets; stents (plastic or metal) can be placed to keep ducts open.
After the procedure
Recovery in the unit for 1-2 hours. Many patients are admitted overnight to monitor for complications (especially pancreatitis, the main risk). Lipase blood test may be checked. You can eat clear liquids same day, soft food next day, normal diet 24-48 hours after. Mild abdominal discomfort is common; severe pain is a red flag.
When you get the results
Verbal findings same day. Pathology from biopsies: 7-14 days. Stent placement effects (resolution of jaundice) appear over days.
Alternatives
MRCP (MRI of the bile ducts) is a non-invasive alternative for diagnosis but cannot treat. Percutaneous transhepatic cholangiography (PTC) is an alternative for treatment when ERCP is not possible — but more invasive.
In Saudi Arabia
ERCP is performed at all Saudi tertiary hospitals and most secondary hospitals. Same-day or 1-night ERCP for cholangitis is the standard of care.
Questions to ask your doctor
• Should I have rectal indomethacin or pancreatic stent to prevent post-ERCP pancreatitis?
• What if you can't reach my bile duct?
• Will I need follow-up ERCP for stent change?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is ERCP (Endoscopic Retrograde Cholangiopancreatography)?
Why is ERCP (Endoscopic Retrograde Cholangiopancreatography) done?
What are the risks of ERCP (Endoscopic Retrograde Cholangiopancreatography)?
How do I prepare for ERCP (Endoscopic Retrograde Cholangiopancreatography)?
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