🧾 Magnetic Resonance Cholangiopancreatography (MRCP) is now the preferred diagnostic tool for suspected biliary obstruction. ⚡ Endoscopic Retrograde Cholangiopancreatography (ERCP) is reserved mainly for therapeutic interventions such as stone extraction, sphincterotomy, and stent placement.

📖 About ERCP

Combines upper GI endoscopy with fluoroscopic X-ray imaging.
Used to visualise the bile ducts, pancreatic duct, and gallbladder.
Crucially, ERCP is both diagnostic and therapeutic (unlike MRCP).

🩺 ERCP Procedure

During ERCP, an endoscope is advanced to the duodenum. The bile duct is cannulated, and contrast dye is injected under X-ray guidance. ➡️ This provides detailed duct imaging and allows real-time interventions (stone removal, stent placement, biopsies).

📌 Indications for ERCP

🪨 Diagnosis and removal of common bile duct (CBD) stones.
🧬 Investigation and dilatation/stenting of biliary strictures (benign or malignant).
🧠 Diagnosis and palliation in cholangiocarcinoma or pancreatic cancer.
✂️ Sphincterotomy – cutting the sphincter of Oddi to aid stone clearance.
🩺 Pancreatic duct stenting in selected cases.
🔬 Biopsy or brush cytology of strictures or tumours.

🔎 Procedure Steps

🔒 Patient fasts and receives IV sedation ± analgesia.
📍 Endoscope passed via mouth → stomach → duodenum.
💉 Cannulation of bile/pancreatic duct, followed by contrast injection.
🧾 X-rays taken to identify stones, strictures, or tumours.
⚙️ Interventions performed as required (stone extraction, stenting, biopsy, sphincterotomy).

🪨 Example: Large CBD Stone

ERCP allows direct removal of obstructing CBD stones, restoring bile flow and preventing jaundice or cholangitis.

⏱️ Duration

Typically lasts 60–120 minutes.
Patients are sedated; recovery requires monitoring for a few hours post-procedure.

📝 Pre-Procedure Checklist

✅ Clotting screen (INR, platelets) if sphincterotomy likely.
✅ Review anticoagulants/antiplatelets → liaise with gastroenterology/haematology if on warfarin or DOACs.
✅ Consent discussion: include risk of pancreatitis, bleeding, infection, perforation.

⚠️ Potential Complications

💤 Sedation-related respiratory compromise.
🩸 Bleeding (~2% risk, especially post-sphincterotomy).
⚡ Acute pancreatitis (~5% risk; most common serious complication).
🦠 Cholangitis (biliary infection).
🕳️ Perforation of duodenum or ducts.
☢️ Cumulative radiation exposure (rarely significant).

📚 References

RUH NHS – Patient Information: ERCP

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Endoscopic Retrograde Cholangiopancreatography (ERCP)