Quick answer: ERCP (endoscopic retrograde cholangiopancreatography) is a specialised procedure that combines endoscopy with X-rays to examine and treat problems of the bile ducts and pancreatic duct. Unlike a diagnostic scan, ERCP can also treat — for example removing a bile duct stone or relieving a blockage that is causing jaundice or infection. In Singapore it is performed by a gastroenterologist or hepatobiliary specialist, usually under sedation, and most people go home the same day.
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If your doctor has recommended ERCP, it is natural to have questions about what it involves and why it is needed. This guide explains what ERCP is, why it is done, how to prepare, what to expect during and after the procedure, and the warning signs to watch for once you are home. It is general information for patients in Singapore and does not replace advice from your own specialist.
What ERCP is
ERCP is a specialised procedure that combines endoscopy — a flexible camera passed through the mouth, down the food pipe and stomach, and into the first part of the small intestine — with X-ray imaging to examine the bile ducts and pancreatic duct. These are the small drainage channels that carry bile from the liver and gallbladder, and digestive juices from the pancreas, into the gut.
What sets ERCP apart from an ordinary scan is that it can also treat. Through the endoscope, the specialist can pass fine instruments to remove a stone stuck in the bile duct, widen a narrowing, or place a small tube called a stent to keep a blocked duct open. Because it carries recognised risks, ERCP is generally reserved for situations where treatment is likely to be needed rather than for diagnosis alone.
Why ERCP is done
ERCP is used to diagnose and, importantly, to treat a range of problems affecting the bile and pancreatic ducts. Common reasons include:
- Removing stones that have moved out of the gallbladder and become stuck in the bile duct.
- Relieving a blocked or narrowed bile duct, including narrowing caused by a tumour, so that bile can drain again.
- Treating a bile leak, sometimes after gallbladder surgery.
- Managing certain pancreatic duct problems.
A frequent aim is to relieve jaundice (yellowing of the skin and eyes) or to treat a bile duct infection (cholangitis), both of which can develop when a duct is blocked. Placing a stent during ERCP can restore drainage and help you feel better quickly.
How ERCP differs from MRCP
You may also hear about MRCP (magnetic resonance cholangiopancreatography). MRCP is a scan — it uses an MRI machine to produce detailed pictures of the ducts for diagnosis only, and involves no endoscope. ERCP is used when treatment is likely to be needed, because it can act on what it finds. In practice, your specialist may use a scan such as MRCP first to map the problem, then recommend ERCP if something needs to be treated.
How to prepare
Your care team will give you specific instructions, which usually include the following:
- Fasting: you will be asked not to eat or drink for a set period beforehand so that your stomach is empty and the procedure is safe.
- Medicines: tell your doctor about everything you take. Blood thinners and some diabetes medicines may need to be paused or adjusted, so ask well in advance rather than stopping anything on your own. Mention any allergies, including to contrast dye.
- Getting home: because you will have sedation, arrange for a responsible adult to accompany you home. You should not drive, operate machinery or make important decisions for the rest of the day.
What happens during the procedure
ERCP is usually done under sedation or a general anaesthetic, so you should not feel discomfort. You lie on an X-ray table, often on your side or front. Once you are comfortable, the specialist gently passes the endoscope through your mouth and down to the opening where the bile and pancreatic ducts drain into the small intestine.
A special dye is injected into the ducts and X-ray pictures are taken, which show up any stones, narrowing or blockage. If a problem is found, treatment can be carried out during the same session — for example removing a stone, widening a narrowing, or placing a stent to hold a duct open. The procedure itself typically takes under an hour, though this varies with what needs to be done.
Recovery
Afterwards you will be monitored in a recovery area while the sedation wears off. It is common to feel a little bloated or to have a mild sore throat for a short while. Many people go home the same day once they are alert, comfortable and able to drink. In some situations — for example after a more complex treatment, or to keep an eye on you — your team may recommend staying in hospital overnight. You will be told when you can eat and drink normally again and given instructions for the days ahead.
Risks and complications
ERCP is generally safe, but because it treats delicate structures it carries recognised risks that your specialist will explain and weigh against the benefit to you. The main one is inflammation of the pancreas (pancreatitis), which causes tummy pain and may require a hospital stay. Other possible complications include bleeding, infection, and a small tear in the gut or duct wall. Your team takes precautions to reduce these risks and monitors you closely afterwards. Understanding the warning signs, below, helps you get prompt care in the uncommon event that a problem develops.
Getting results and next steps
Your specialist can often tell you straight away what was found and what was done, though you may still be drowsy from sedation, so it helps to have someone with you and to receive written instructions. If tissue samples were taken, results follow at a later appointment. Depending on the findings, next steps might include follow-up imaging, a plan to remove the gallbladder, a repeat ERCP to change or remove a stent, or referral for further treatment. Your team will explain the plan and when to return.
When to seek urgent help after ERCP
Most people recover without trouble, but contact your care team, go to the nearest A&E, or call 995 if after the procedure you have:
- Severe or worsening tummy pain (a possible sign of pancreatitis).
- Fever or chills.
- Persistent vomiting.
- Black, tarry stools or vomiting blood.
Go straight to A&E or call 995 if the pain is severe or you feel very unwell.
Common questions
Will ERCP hurt?
The procedure is done under sedation or anaesthetic, so you should not feel pain during it. Afterwards a mild sore throat or bloating can occur and usually settles quickly.
How long does it take?
The procedure itself is often completed within about an hour, but you should plan for a longer visit to allow for preparation and recovery from sedation.
Can I eat and drink normally afterwards?
Your team will tell you when to restart food and drink. Many people resume eating the same day, but follow the specific advice you are given.
Is a stent permanent?
Not always. Some stents are temporary and are removed or exchanged at a later ERCP, while others may stay longer. Your specialist will explain what applies to you.
Do I still need my gallbladder removed if stones were cleared?
Clearing a bile duct stone does not treat the gallbladder itself. Your specialist may recommend gallbladder surgery separately to prevent further problems — discuss this with your team.
Related guides
Sources
- Singapore General Hospital
- HealthHub
- American College of Gastroenterology
- NHS
Important: This guide is general information and does not replace advice from a doctor. It cannot diagnose your condition. If you develop severe tummy pain, fever, vomiting, black stools or vomiting blood after ERCP — or feel very unwell — go to your nearest A&E or call 995.