ERCP (Endoscopic Retrograde Cholangiopancreatography)
A specialized endoscopy that examines and TREATS problems in the bile ducts and pancreas — like removing stones, opening blockages, placing stents — without surgery.
Results
Verbal findings same day. Pathology from biopsies: 7-14 days. Stent placement effects (resolution of jaundice) appear over days.
Video explainer
3:35
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
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.
Why is it 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.
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
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).
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.
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
When you get results
Alternatives if you decline
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 the Saudi context
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
Save this list or print it before your appointment — doctors appreciate prepared patients.
- 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?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026