ERCP treatment may be recommended for bile duct obstruction, jaundice, bile duct stones or narrowing of the bile duct. ERCP is primarily used to treat problems affecting the bile ducts, while endoscopic ultrasound provides detailed imaging of the pancreas, gallbladder and bile duct and can also be used to guide a biopsy when required.

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a specialist endoscopic procedure used to access the opening of the bile duct in the duodenum, known as the ampulla. A side-viewing endoscope is passed through the mouth, oesophagus and stomach into the first part of the small intestine. X-ray guidance is then used to assess the bile duct and, where appropriate, treat any obstruction during the same procedure.

ERCP is most commonly recommended when treatment is likely to be required. This may include removing a bile duct stone, inserting a stent into a narrowed bile duct or relieving jaundice caused by an obstruction. Bile duct blockages can result from stones, inflammation, scarring, strictures or growths affecting the pancreas or bile duct.

The procedure is carried out with sedation or anaesthetic support. The endoscope is passed gently through the mouth into the duodenum, and contrast dye may be injected into the bile duct so that it can be viewed on X-ray. If a stone, narrowing or blockage is identified, instruments can be passed through the endoscope to remove stones, widen the opening or insert a plastic or metal stent.

As a specialist procedure, ERCP carries a small risk of complications. These can include pancreatitis, bleeding, infection of the bile ducts and, rarely, perforation. Your specialist will explain why the procedure has been recommended and discuss the potential risks and benefits with you beforehand.

Endoscopic ultrasound, often shortened to EUS, uses a flexible endoscope with an ultrasound probe at its tip. As the probe is positioned very close to the pancreas, gallbladder and bile duct, EUS can produce highly detailed images. It may detect small stones, biliary sludge, pancreatic abnormalities and enlarged lymph nodes that are not clearly visible on standard scans.

EUS may be recommended to investigate unexplained upper abdominal pain, suspected bile duct stones, abnormal pancreatic imaging, pancreatic cysts, possible pancreatic inflammation or a suspected lump. In some cases, it can also be used to obtain a fine needle biopsy from the pancreas or nearby lymph nodes.

EUS is mainly used for diagnosis and can help confirm whether a bile duct stone or pancreatic abnormality is present. ERCP is generally reserved for situations where treatment is expected to be necessary, such as removing a bile duct stone or inserting a stent. Your surgeon or gastroenterologist will recommend the most appropriate investigation based on your symptoms, blood test results and previous scans.

If you have jaundice, abnormal liver function tests, suspected bile duct stones or unexplained pancreatic symptoms, The Gallstone Clinic can arrange a specialist assessment and advise whether ERCP, EUS, MRCP, CT or another investigation is most appropriate.