Procedure · Silo Endoscopy · Colombia 2026
ERCP: endoscopic retrograde cholangiopancreatography — complete guide
ERCP is the most complex endoscopic procedure in gastroenterology — it diagnoses and treats common bile duct stones, biliary strictures, and pancreatic pathology using a duodenoscope without open surgery. Technical guide Colombia 2026
ERCPEndoscopic retrograde cholangiopancreatographyCommon bile duct stonesDuodenoscopeBiliary endoscopy Colombia 2026
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GSMED Imaging medical team — biliary pancreatic endoscopy Colombia
Based on: ASGE Guidelines on ERCP 2025, ESGE Clinical Guideline on ERCP 2023, Dumonceau 2024 meta-analysis, and advanced biliary endoscopy practice in Colombia.
May 2026ASGE 2025 · ESGE 2023 · Dumonceau 2024
ERCP (endoscopic retrograde cholangiopancreatography) is the most technically complex endoscopic procedure in gastroenterology — and also one of the most useful: it allows visualization and treatment of the bile ducts and pancreatic duct from inside the duodenum, without open surgery. An expert interventional gastroenterologist can extract a common bile duct stone obstructing bile flow in less than 30 minutes.
1. What is ERCP and what does it allow
ERCP combines endoscopy with fluoroscopy (real-time X-rays) to visualize and treat the biliary tract and pancreatic duct. The gastroenterologist introduces a duodenoscope — a side-view endoscope specifically designed for this procedure — into the second part of the duodenum, where they locate the ampulla of Vater (the opening through which the common bile duct and pancreatic duct empty) and cannulate the bile or pancreatic ducts with a catheter or a metal guide.
90%
Success in common bile duct stone extraction without open surgery in expert hands
Duodenoscope
Side-view — exclusive to ERCP, different from the standard front-view gastroscope
General anesthesia
Always under general anesthesia — the longest and most complex procedure in GI endoscopy
Fluoroscopy
Real-time X-rays guide advancement through the bile ducts
2. Indications for ERCP — when it is performed
🪨Common bile duct stones (choledocholithiasis)
The most frequent indication — extraction of stones from the common bile duct that cause obstructive jaundice, cholangitis, or biliary pancreatitis. ERCP with sphincterotomy and stone extraction with a balloon or Dormia basket is the treatment of choice — more effective and less invasive than surgery.
→ Most frequent indication · Obstructive jaundice · Cholangitis
📏Biliary strictures
Narrowing of the bile duct due to post-surgical scars, cholangiocarcinoma, compression by a pancreatic tumor, or primary sclerosing cholangitis. ERCP allows dilation of the stricture and placement of a metal or plastic biliary stent that keeps the duct open and drains bile.
→ Biliary stent · Cholangiocarcinoma · Post-surgical
🔴Biliary pancreatitis
Acute pancreatitis of biliary origin occurs when a common bile duct stone obstructs the ampulla of Vater and blocks the drainage of pancreatic juice. Emergency ERCP (within the first 24–72 hours) is indicated when there is concomitant cholangitis — it extracts the stone blocking the ampulla and decompresses the biliary tract.
→ Emergency in cholangitis · 24–72 h · ESGE 2023
🔵Pancreatic pseudocyst and ductal pathology
Drainage of large pancreatic pseudocysts, pancreatic duct strictures (chronic pancreatitis), pancreatic duct stone extraction, and placement of pancreatic stents for chronic pancreatitis pain.
→ Pseudocyst · Chronic pancreatitis · Duct stones
3. The duodenoscope — the exclusive endoscope for ERCP
Why ERCP needs a different endoscope from all the others
The duodenoscope is the only side-view endoscope in gastroenterology — unlike all the others (gastroscopy, colonoscopy, bronchoscopy), which have a front view. This side view allows the endoscopist to see the ampulla of Vater face-to-face — head-on — when the endoscope is positioned in the second part of the duodenum, which is the only perspective that allows precise cannulation of the bile ducts. The Olympus TJF-Q190V and Fujifilm ED-580XT duodenoscopes are the most used in Colombia. They incorporate a distal tip elevator that allows angling it to direct the catheter exactly toward the ampulla opening.
4. Biliary sphincterotomy — the critical step
Once the common bile duct is cannulated, the gastroenterologist performs endoscopic biliary sphincterotomy (EBS): cutting the sphincter of Oddi with a sphincterotome (a catheter with a wire that conducts high-frequency electrical current). This cut widens the ampulla opening, allowing the extraction of larger stones and the placement of larger-caliber stents. Sphincterotomy is irreversible — once the sphincter is cut, it does not reconstitute — but its long-term clinical consequences are generally minimal.
5. ERCP complications — the most important
| Complication |
Incidence |
When it occurs |
Prevention |
| Post-ERCP pancreatitis |
3–5% overall · up to 15% in risk groups |
Hours after the procedure — abdominal pain + elevated lipase |
Prophylactic 100 mg rectal indomethacin (ESGE 2023 — standard of care) |
| Post-sphincterotomy hemorrhage |
1–2% |
Immediate or delayed up to 14 days |
Correction of prior coagulopathy · Local epinephrine if bleeding is seen |
| Post-ERCP cholangitis |
1–3% |
24–72 h after the procedure — fever + jaundice |
Prophylactic antibiotic · Ensure complete biliary drainage |
| Duodenal or biliary perforation |
0.3–0.6% |
Immediate — severe pain, subcutaneous emphysema |
Careful technique · Continuous fluoroscopy |
How does ERCP differ from magnetic resonance cholangiopancreatography (MRCP)?
The MRCP (magnetic resonance cholangiopancreatography) is a non-invasive diagnostic study that generates images of the biliary and pancreatic tract without endoscopy or radiation — perfect for diagnosis when it is unknown if there are stones in the common bile duct. ERCP is simultaneously diagnostic and therapeutic — when it is done, it is generally because something requiring treatment is already suspected. The ASGE 2025 guidelines recommend doing MRCP first when the probability of choledocholithiasis is intermediate — if stones are confirmed, then therapeutic ERCP is performed to extract them.
Duodenoscopes and systems for ERCP available in Colombia — GSMED
Olympus TJF-Q190V and ERCP accessories (sphincterotomes, guides, baskets, stents) — authorized distributors with local technical support.
Request information →
Sources
- ASGE. Role of ERCP in diseases of the biliary tract and the pancreas. asge.org. 2025. ASGE 2025
- ESGE. Clinical Guidelines on ERCP. esge.com. 2023. Post-ERCP pancreatitis, prophylactic indomethacin. ESGE 2023
- Dumonceau JM et al. ERCP complications — meta-analysis. Endoscopy. 2024. Dumonceau 2024
