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ERCP, otherwise know as endoscopic retrograde pancreatography is an endoscopic test, usually undertaken by gastroenterologists with hepato-biliary subspecialist interest. During this test a side-viewing (as opposed to the “normal” front viewing endoscope) is passed through the oesophagus, and stomach and into the second part of the duodenum where the opening of the bile and pancreatic ducts converge to form the ampulla. A small cannula is then passed into the ampulla, where radiopaque contrast (dye) is then injected into the biliary and sometimes the pancreatic duct in order to get clear pictures of them and their contents.  This can then lead on to other interventions to either place stents (drains) within narrowed segments or to remove stones.

ERCP is not without risks, approximately one in 20 patients may develop pancreatitis as a result of the procedure. This is usually mild and self -limiting but can be severe or even life threatening. If a cut is made to the tissues around the ampulla either to enable access or to remove stones this carries a risk of causing either perforation (1:100) or significant bleeding 1:100). If the risks of ERCP are thought to be significant and the need for biliary intervention (For example insertion of stents or removal of stones) is not certain patients may undergo and MRCP or EUS first in order to better define the pro’s and cons of intervention.

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