An ERCP is a procedure that can help to diagnose and treat disorders of the pancreas, pancreatic duct and bile ducts. The doctor steers a flexible tube (endoscope), which is about as wide as a finger, through your mouth and down the oesophagus, through your stomach and into the duodenum (the top part of the small bowel). On the end of the endoscope is a light and a tiny camera. The doctor then inserts a thin catheter (a tube less than two millimetres wide), through the connection to the bile duct in the wall of the duodenum (the papilla), which bile and pancreatic juice pass through. X-ray dye can then be injected into the ducts, to identify any abnormalities such as gallstones or strictures (narrowings).
ERCP also allows us to perform a range of procedures if needed. These include taking samples (biopsies), placing tubes (stents) to relieve a blockage, or removing gallstones.
ERCP is also the starting point for other techniques, including cholangioscopy. Cholangioscopy allows further detailed assessment of the ducts of the liver and pancreas. Cholangioscopy can also be used to treat gallstones.
ERCP is a generally safe procedure but there are risks.
Endoscopy
Unusual complications which can occur during any procedure that involves an endoscopy include:
- chest infection
- a hole (perforation) or tear in the wall of the oesophagus, stomach or duodenum
- allergy to sedative medication
- bleeding
- damage to teeth
ERCP
Complications specific to ERCP include:
inflammation of the pancreas (pancreatitis). Certain measures may reduce the risk of pancreatitis (e.g. an anti- inflammatory suppository), and these may be discussed with you during the consent process. Although pancreatitis is always unpleasant and may require a longer stay in hospital, on rare occasions it can be fatal.
bleeding, usually if a cut of the sphincter at the lower end of the bile duct has been performed).
infection within the bile duct (cholangitis). These complications usually settle down by themselves, but may require a longer stay in hospital, and may require urgent treatment (very occasionally this can mean surgery).
The risk of having a complication is generally 5-10%, but certain indications and interventions during ERCP may increase the risk (up to 20%). The chance of dying within thirty days of having an ERCP is about one in two hundred (0.5%). Most deaths result from an underlying medical problem but there is a very small risk of death from a direct complication of an ERCP. We will discuss the specific risks for your procedure with you.
Sometimes it is not possible to complete the procedure. This may be because we cannot access the bile ducts or other structures. Sometimes a gallstone or stricture may make access difficult. If we are planning treatment, it may not always be possible to complete the treatment successfully.
You will usually need to have a blood test shortly before your ERCP, usually within the previous two weeks. If these have been performed locally or through your GP it is important that you obtain a copy of the results and bring this with you. If these are not available your procedure may be cancelled.
Since X-rays are taken during the procedure, please tell us in advance if there is any possibility you may be pregnant.
Please let us know as soon as possible about all the medications you take, in particular blood thinners (e.g. clopidogrel, warfarin, or rivaroxaban). These medications may need to be stopped or adjusted up to one week before the procedure.
If you take clopidogrel or other blood thinners, it may be necessary to check with your cardiologist (or other specialist) to be sure that these can be discontinued before your ERCP. There is usually no need to stop aspirin prior to ERCP.
Please continue to take any other medication (including laxatives).
You should not eat anything for six hours before your appointment.
You may drink water only for up to four hours before your procedure. You can take you usual prescription medicines with a sip of water).
If you are a diabetic and take insulin, it is important that you continue taking your insulin but we suggest that you reduce your dose the night before the procedure and on the day. If you are concerned, please contact your local diabetes nurse for advice. To keep you safe for the procedure, please check your blood sugars every three to four hours from the time you stop eating.
If you are taking tablets for your diabetes, please do not take them on the day of the procedure until after the procedure has been done. Please bring your diabetic tablets or insulin to the hospital with you.
When you arrive at University Colleage Hospital please come to the 2nd floor Podium and report to the Endoscopy Unit reception. From there a nurse will take you to the admissions area, check your personal details, check your blood pressure and ask you to change into a hospital gown. Before your ERCP we will discuss the procedure further as part of the consent process.
Sometimes due to emergencies and other circumstances your appointment may be delayed or postponed. We try our best to see everyone on time but please understand that delays can occur.
Occasionally you may be asked to come in early for the anaesthetist to see you and adequately prepare you for the procedure.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. The doctor will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak with a senior member of staff again.
The procedure is performed on an X-ray table. We may numb your throat with some local anaesthetic spray, and you will be given medications by injection through a vein to make you sleepy and relaxed. Occasionally the procedure is performed with a full general anaesthetic, but this is not usually necessary. We will ask you to lie on your front in a position a bit like swimming the front crawl. A mouth guard will be placed to protect your teeth. While in this position, the doctor will pass the endoscope through your mouth and down your throat. The endoscope will not interfere with your breathing but can be uncomfortable. We will try to make the procedure as comfortable as possible. The examination usually takes about half an hour, but more complex treatment procedures may take more than an hour.
Some abdominal discomfort and bloating is common. This usually settles after a few hours. Your throat may feel numb and slightly sore, and because of the local anaesthetic and sedation, you should not try to eat or drink anything for at least one hour.
We will normally observe you for two to four hours in the department and advise you not to eat for four hours.
One of the doctors will review you if you are due to go home after the procedure. If you are due to stay in hospital after the procedure you will be transferred to the ward.
You must be accompanied home by a responsible adult if you are going home on the same day as your ERCP. They must also stay with you for 24 hours after the procedure.
Do not drive yourself. Please arrange for someone to take you home in a car or taxi (public transport is not recommended).
Do not drink alcohol for 24 hours after sedation, make important decisions or sign important documents.
Do not drive a car or operate heavy machinery and / or appliances, such as cookers and kettles, for 24 hours after sedation.
The following symptoms might suggest a complication:
- severe persistent pain
- light-headedness, or fainting
- shivering or fever
- vomiting of blood
- passing of blood or black tar-like stools
- feeling generally very unwell.
If you have any problems, please contact the Hepatobiliary Team Pathway Co-ordinator or Specialist Nurse in the first instance.
If you have a problem outside of office hours which cannot wait until the next day, please contact the hospital switchboard and ask to be put through to the on call Gastroenterology Registrar. In an emergency please visit your nearest Emergency Department.
Contact information is provided below.
Endoscopy Booking Team (Monday to Friday 09:00-17:00)
Direct line: 020 3456 7022
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 67022
E-mail: uclh.
Endoscopy Recovery (Monday to Friday 09:00-17:00)
Direct line: 020 3447 3282
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 73282
Hepatobiliary Pathway Co-ordinator (Monday to Friday 09:30-17:30)
Direct line: 020 3447 9229
Switchboard: 0845 155 5000 / 020 3456 7890 ext. 79229
Hepatobiliary Clinical Nurse Specialist (Monday to Friday 09:00-17:00)
Mobile: 07967 760 146
On-call Gastroenterology Registrar (out of hours emergencies only)
Switchboard: 0845 155 5000 / 020 3456 7890
Address: Endoscopy Unit, University College Hospital, 2nd Floor Podium, 235 Euston Road, London, NW1 2BU
Services
Page last updated: 11 June 2025
Review due: 01 June 2027