Benefits, Risks, and Alternatives

Benefits
ERCP allows providers to evaluate and treat problems in the bile and pancreatic ducts. Most other diagnostic tests cannot treat blockages or narrowing of the bile and pancreatic ducts.

Risks
Research has found that five to 10 percent of patients experience complications from ERCP procedures. These complications often require treatment at a hospital. They can include:

  • Pancreatitis, or severe inflammation of the pancreas
  • Infection of the bile ducts or gallbladder
  • Excessive bleeding, called hemorrhage
  • An abnormal reaction to the sedative, including breathing or heart problems
  • Perforation, or a partial tearing, in the bile or pancreatic ducts, or in the duodenum where the bile and pancreatic ducts empty into it
  • Tissue damage from x-ray exposure
  • Rarely, death

Alternatives
There are alternative methods of diagnosing problems in the bile and pancreatic ducts, but most of them cannot be used for treatment as ERCP can. Alternative procedures include:

  • Magnetic resonance cholangiopancreatography, or MRCP, which uses a combination of radio waves and magnets to create images of the bile ducts and pancreas.
  • Cholescintigraphy, also known as a HIDA scan, which is a nuclear imaging study used to evaluate the function of the gallbladder and diagnose obstruction of bile ducts.
  • Percutaneous transhepatic cholangiography, or PTC, which may be used if ERCP is unsuccessful. A thin needle is inserted through the skin and into the liver, and dye is injected to make the liver and bile ducts more visible on x-ray. Tissue samples can be taken and stents can be placed in bile ducts.
  • Abdominal ultrasound, which uses high-frequency sound waves to create images of abdominal organs and soft tissues. This can be used to evaluate the liver, gallbladder, and bile ducts, but is notoriously ineffective for evaluating the pancreas due to the organ's deep position within the body.
  • Computed tomography, or CT, scan, which uses a combination of x-rays and computer technology to create images of organs and tissues.
  • Endoscopic ultrasound, or EUS, which uses an endoscope with an ultrasound probe at the end. This has excellent imaging detail, but does not allow for the same type of intervention as ERCP. However, the gastroenterologist performing the ERCP may perform an EUS at the same time as, or just prior to, the ERCP, to ensure ERCP is necessary due to its increased risks.