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ERCP (endoscopic retrograde cholangiopancreaticography) is an endoscopic method that uses x-ray contrast agent to generate images of the bile duct, gallbladder and pancreatic duct. The advantage of this method is that it allows doctors to perform treatment procedures while they are conducting a diagnosis.

ERCP image of a pancreatic tumour and gallstone

© Prof. Dr. med. Hasan Kulaksiz
  1. Liver
  2. Gallbladder
  3. Gallstones
  4. Bile duct
  5. Tumour
  6. Endoscope and bile duct wire
  7. Duodenum
  8. Pancreas
  9. Stomach

ERCP procedure

An endoscope with side-viewing optics (duodenoscope) is inserted through the mouth and pushed into the duodenum, where the surgeon then locates and probes the ampulla of Vater (opening of the common bile duct and pancreatic duct). After contrast agent is injected into the bile ducts, gallstones, constrictions in the bile ducts and tumours become visible under fluoroscopic imaging.

Possible surgeries:

  • Dilation of the papilla through an incision or balloon dilation (papillotomy, sphinchteroplasty)
  • Removal of bile duct stones
  • Dilation and stent placement (plastic or metal stents) for inflammatory or malignant constrictions in the bile ducts (e.g. for pancreatic cancer or Klatskin tumours)
  • Treatment of bile duct stenoses and leakages resulting from surgery 
  • Radiofrequency ablation of bile duct cancers
  • Removal of tumours on the ampulla of Vater (ampullary adenoma)
  • Treatment of haemorrhages in the duct system
  • Use of percutaneous transhepatic procedures with cholangiography (PTC), cholangioscopy (PTCS) as well as drainage (PTCD) after endoscopic methods were unsuccessful
  • Dilation of the pancreatic duct through incision (papillotomy) for functional disorders of the sphincter with repeated pancreatic inflammation (pancreatides), pancreas divisum with concomitant pancreatides, chronic pancreatitis in combination with further procedures
  • Dilation (use of a bougie, dilatation) and prosthetic fitting for constrictions of the pancreatic duct system resulting from inflammation (in particular for chronic pancreatitis)
  • Removal of pancreatic duct stones; in complicated cases also mechanical lithotripsy
Centre for Gastrointestinal Diseases
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