ERCP Procedure

How is ERCP performed?
Patients will receive a anesthetic administered by an anesthesiologist. An intravenous needle is inserted into a vein in the arm to administer sedatives. Vital signs are monitored while patients are sedated.

During ERCP, patients lie on their stomach (prone position) on an x-ray table. Dr. Jones inserts an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted from a small camera attached to the endoscope to a computer screen within Dr. Jones’ view. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier to examine.

When Dr. Jones locates the duodenal papilla, a blunt tube called a catheter is slid through the endoscope and guided through the papillary opening. Once the catheter is inside the papilla, a wire or dye is injected into the ducts. The dye, also called contrast medium, allows the ducts to be seen on x-rays. X-rays are then taken to see the ducts and to look for narrowed areas or blockages.

Procedures to treat narrowed areas or blockages can be performed during ERCP. To see the ducts during treatment procedures, Dr. Jones uses x-ray video, also called fluoroscopy. Special tools guided through the endoscope and into the ducts allow Dr. Jones to open blocked ducts, break up or remove gallstones, remove tumors in the ducts, or insert stents. Stents are plastic or expandable metal tubes that are left in narrowed ducts to restore the flow of bile or pancreatic juice. A kind of biopsy called brush cytology allows Dr. Jones to remove cells from inside the ducts using a brush that fits through the endoscope. The collected cells are later examined with a microscope for signs of infection or cancer.

There are multiple methods to remove common bile duct stones: balloon extraction, mechanical lithotripsy and laser lithotripsy.

Occasionally, ERCP is done after gallbladder surgery, if a surgical bile leak is suspected, to find and stop the leak with a temporary stent.