ERCP (Endoscopic Retrograde Cholangiopancreatography)

A specialized endoscopic procedure to treat obstructions of the bile and pancreatic ducts without a surgical incision.

What is it?

ERCP is an advanced endoscopic technique that provides access to the bile ducts and the pancreatic duct through the natural orifices. A specialized endoscope is passed through the mouth down to the duodenum, where these ducts open; a contrast agent and X-ray guidance then direct the therapeutic maneuvers. Its main value is therapeutic: extraction of stones from the main bile duct, relief of an obstruction causing jaundice, placement of stents to restore the flow of bile. In many situations, it thereby avoids more invasive surgery. ERCP is performed under general anesthesia, in a room equipped for both endoscopy and radiology. At Clinique Pasteur Tunis, this procedure is carried out by operators trained in interventional endoscopy, with systematic post-procedure monitoring as an inpatient.

When is it indicated?

Stone in the main bile duct

When a stone blocks the duct that carries bile to the intestine, ERCP allows it to be extracted through the natural orifices, without an incision.

Jaundice (icterus) due to an obstruction of the bile ducts

When bile no longer flows and the skin turns yellow, this procedure relieves the obstruction and causes the jaundice to subside.

Cholangitis (infection of the bile ducts) requiring drainage

When blocked bile becomes infected, it must be drained quickly: ERCP restores its flow.

Narrowing of the bile or pancreatic ducts requiring treatment

A narrowed duct can be widened or kept open by a small stent placed during the procedure.

Bile leak after surgery requiring stent placement

After certain operations, a bile leak can occur; a stent placed endoscopically helps it heal.

Certain cases of pancreatitis related to a duct obstruction

When inflammation of the pancreas is due to a blockage of its ducts, relieving that obstruction contributes to recovery.

Preparation

1Pre-procedure work-up: blood tests and imaging of the bile ducts

2Anesthesia consultation

3Fasting for 6 hours before the procedure

4Adjustment of anticoagulants and antiplatelet agents according to medical advice

5Report any allergies, particularly to contrast agents

Procedure

General anesthesia

Insertion of the endoscope through the mouth down to the duodenum

Identification of the opening of the bile and pancreatic ducts

Injection of contrast agent and X-ray control

Therapeutic maneuver: stone extraction, dilation or stent placement

Monitoring in the recovery room, then as an inpatient

Duration

30 minutes to 1 hour 30

Aftercare & Recovery

ERCP most often relieves the obstruction in a single session: pain and jaundice subside gradually. A short period of inpatient monitoring is usual. The report and the next steps in care are explained to the patient before discharge.

Risks and side effects

Temporary pancreatic reaction (pancreatitis), systematically monitored after the procedure

Bleeding at the papilla, usually controlled endoscopically

Infection of the bile ducts, prevented by appropriate measures

Perforation, a rare complication managed without delay

These risks remain rare. Your surgeon will inform you in detail before the procedure.

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At a glance

Duration: 30 minutes to 1 hour 30

Preparation: Required

Dedicated specialist team

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