What are the Different Types of ERCP Procedures?

Lynda Lampert

ERCP stands for endoscopic retrograde cholangiopancreatography, a medical technique used to diagnose specific problems of the pancreatic or biliary ductal systems. The different types of ERCP procedures focus on an endoscopic look at the bile ducts of the pancreas, gallbladder and part of the bile duct tree that interfaces with the liver. While in the vicinity of these anatomical structures, the ERCP endoscope can remove a sphincter from the biliary system, remove gallstones or place stents. These ERCP procedures are usually done under light anesthesia with the use of both endoscopy, fluoroscopy and angiography to track any blockages in the biliary tree.

Endoscopy is used during ERCP procedures.
Endoscopy is used during ERCP procedures.

For any ERCP procedures, the patient lies on his or her left side, usually lightly sedated and anesthetized. This procedure uses an endoscope, which is a small camera on the end of a long, flexible hose, and it is introduced via the mouth and guided down the esophagus to the stomach. It passes out of the stomach to the start of the small intestines, which is known as the duodenum. It is where the openings to the pancreatic and common bile ducts are located.

ERCP procedures carry the risk of perforating the small intestine.
ERCP procedures carry the risk of perforating the small intestine.

One of the trademark things about ERCP procedures is the use of fluoroscopy. Fluoroscopy is a special type of X-ray that allows the doctor to see the structures of the body in real time. Angiography is also used to highlight the vessels and ducts of the gallbladder and pancreas.

Using these tools, the physician will highlight the biliary tree to see whether there are any blockages or strictures that need to be addressed. From this point, the doctor can use the endoscope to address issues by dilating a stricture, placing a stent or removing a stone. During this time, the patient is asleep and will not remember any of the procedure. Vital signs are closely monitored, and the patient is kept sleeping.

There are some risks with ERCP procedures, such as pancreatitis. Pancreatitis is characterized by severe abdominal pain, nausea and vomiting. Although it is a risk with ERCP procedures, it also is a risk of gall stones and biliary strictures. The risk of pancreatitis from an ERCP is about 5 percent. Other risks include perforation of the small intestine and an allergic reaction to the iodine-containing contrast used for the imaging segment of the procedure.

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