Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is both a diagnostic test and a treatment technique. It is the gold standard for detection of gallstones in the common bile duct, which carries secretions from both the gallbladder and the pancreas into the small intestine. ERCP is also the best method for removing gallstones from bile ducts.

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During the procedure, the patient is sedated enough to relax, then swallows a long and flexible lighted tube, called an endoscope, attached to a computer and video monitor. The physician puts the tube through the stomach into the duodenum, the first portion of the small intestine. The endoscope allows the physician to see the structures inside the intestine. The endoscope is also equipped with accessories, such as tiny brushes, forceps, baskets, balloons, and stents, which can be placed into the biliary and pancreatic ducts to find, remove, or break apart stones. A dye is injected into the pancreatic and bile ducts to obtain X-ray images of ducts. With this procedure, the physician is able to see two sets of images: the endoscopic view of the intestine and the X-ray images of the bile and pancreatic ducts. Pictures and video can be taken for later review of the patient's condition and options.

Possible complications of ERCP include inflammation of the pancreas (pancreatitis) and, less commonly, infection, bleeding, and perforation of the duodenum.