What is ERCP?
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a minimally invasive procedure that combines endoscopy and fluoroscopy to diagnose and treat diseases of the biliary tree and the pancreatic duct.
Using a specialized endoscope that reaches the ampulla of Vater, the physician can cannulate the ducts and perform targeted interventions such as sphincterotomy, stone extraction, dilatations, or stent placement.
ERCP is used today primarily as a therapeutic procedure, since purely diagnostic cases are covered by MRCP or endoscopic ultrasound (EUS). Thanks to its targeted approach, ERCP has replaced surgery in many cases, reducing recovery time and complications.
When is it indicated?
ERCP is indicated in cases where there is obstruction or dysfunction of the bile ducts or the pancreatic duct, such as:
- Choledocholithiasis – presence of stones or “biliary sludge” in the common bile duct, which may cause jaundice, cholangitis, or pancreatitis.
- Obstructive jaundice, either due to benign causes (strictures, post-traumatic injury, chronic pancreatitis) or malignancies (tumors of the bile ducts, pancreas, or duodenum).
- Biliary strictures after surgical procedures or inflammatory conditions.
- Bile leaks (e.g., after cholecystectomy or injury to the common bile duct).
- Restoration of duct patency in inoperable tumors of the area (bile ducts, pancreas, duodenum), through stent placement.
Preparation for ERCP
ERCP is a specialized endoscopic procedure that requires proper preparation to ensure the safety and success of the intervention.
Before the procedure:
- Fasting is required for 6–8 hours, so that the stomach is empty, allowing clear visualization and safe execution of the procedure.
- The patient should inform the physician about the use of anticoagulant or antiplatelet medications, any allergies, or serious comorbid conditions (cardiopulmonary, metabolic, etc.).
- The procedure is performed in a hospital setting, with anesthesiology support and continuous monitoring of vital signs.
SpyGlass™ Cholangioscopy is an advanced endoscopic technique that allows direct visual inspection of the inside of the bile ducts, using a very thin and flexible endoscope that is inserted through the working channel of the standard duodenoscope during ERCP.
Indications for use:
• Indeterminate biliary strictures, where targeted biopsy sampling with high diagnostic accuracy is required — particularly in cases suspicious for malignancy or chronic inflammation.
• Large or difficult stones in the common bile duct, managed with intraductal lithotripsy (laser or mechanical) under direct visualization, without the need for surgical intervention.
The SpyGlass™ method is performed exclusively in specialized centers and works as a complementary tool to ERCP, offering:
• More accurate diagnosis,
• Targeted therapy, and
• Reduced need for repeated or surgical procedures.
With the use of SpyGlass™ technology, the gastroenterologist gains full, direct visualization of the biliary system, ensuring maximum accuracy and safety for the patient.
Frequently Asked Questions (FAQ)
Is ERCP painful?
No. The procedure is performed under sedation, so the patient does not feel pain or discomfort.
