Gastroenterology and hepatology
Endoscopic retrograde cholangiopancreatography
ERCP as a treatment, not a diagnostic test. Indications, preparation (antithrombotics, antibiotics), reading the cholangiogram and the report, preventing post-ERCP pancreatitis with rectal NSAIDs and pancreatic stents, and working up pain afterwards.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- ERCP passes a side-viewing duodenoscope to the papilla, cannulates the bile or pancreatic duct and injects contrast under fluoroscopy.
- It is a therapeutic procedure. Use MRCP or EUS to diagnose, ERCP to treat.
- Post-ERCP pancreatitis (PEP) is the main complication, in about 3 to 5% overall and up to 15% in high-risk patients. Rectal NSAIDs and pancreatic stents cut it.
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Sources
- Buxbaum JL et al. American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations. Gastrointest Endosc 2023;97:153-62American Society for Gastrointestinal Endoscopy, 2023
- Dumonceau JM et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020;52:127-49European Society of Gastrointestinal Endoscopy, 2020
- Buxbaum JL et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019;89:1075-105American Society for Gastrointestinal Endoscopy, 2019
- Manes G et al. Endoscopic management of common bile duct stones: ESGE guideline. Endoscopy 2019;51:472-91European Society of Gastrointestinal Endoscopy, 2019
- Veitch AM et al. Endoscopy in patients on antiplatelet or anticoagulant therapy: BSG and ESGE guideline update. Gut 2021;70:1611-28British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy, 2021
- Elmunzer BJ et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012;366:1414-22New England Journal of Medicine, 2012
- Fogel EL et al. Rectal indometacin dose escalation for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography in high-risk patients: a double-blind, randomised controlled trial. Lancet Gastroenterol Hepatol 2020;5:132-41Lancet Gastroenterology & Hepatology, 2020
- Elmunzer BJ et al. Indomethacin with or without prophylactic pancreatic stent placement to prevent pancreatitis after ERCP (SVI): a randomised non-inferiority trial. Lancet 2024;403:450-8The Lancet, 2024
- Therapeutic Guidelines: Gastrointestinal and Antibiotic (eTG complete), biliary tract infections and surgical prophylaxisAU/NZTherapeutic Guidelines Limited
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Deploy to Cloudflare on push to main