Gallstones can resettle from the gallbladder into the common bile duct (choledocholithiasis). A gallstone stuck in the bile duct can cause obstructive jaundice, and the bile can become infected. Bacteria from infected bile can spread rapidly into the blood leading to cholangitis and septicaemia.

Endoscopic retrograde cholangiography (ERCP) is an endoscopic procedure done to:

  • Remove stones or other intraluminal obstructions from the central bile duct or intrahepatic bile ducts.
  • Biopsy and stent tumours that are obstructing the primary bile duct, as well as placing stents for bile duct injuries etc.
  • Place stents in the pancreatic duct for patients with chronic pancreatitis causing severe chronic pain or for leaks from the pancreatic duct.

How endoscopic retrograde cholangiography (ERCP) is performed

Endoscopic retrograde cholangiography (ERCP) combines X-ray, and the use of a side-viewing duodenoscope to diagnose and treat diseases of the liver, pancreas, gallbladder and bile ducts. It is usually done under general anaesthesia or sedation by a specialist anaesthetist.

The gastroenterologist inserts the endoscope through the mouth, down the oesophagus and stomach into the duodenum to cannulate the duodenal papilla. The doctor then passes a tube through the endoscope and injects a contrast dye which highlights the examined biliary tree ducts on X-ray. After taking X-rays of the biliary tree, stones are removed with a balloon catheter or Dormier basket or stents are placed over a guidewire under fluoroscopic imaging control. It is often necessary to partially cut the sphincter of Oddi to facilitate stone retrieval.

After endoscopic retrograde cholangiography (ERCP)

After endoscopic retrograde cholangiography (ERCP), the patient will often spend a day or two in the hospital for monitoring, because occasionally complications like bleeding, pancreatitis and duodenal perforation occur.


Dr Graham Stapleton is registered with the Health Professions Council of South Africa as a General Surgeon.

He specialises in liver and pancreatic surgery, with particular emphasis on removal of tumours of the liver and pancreas as well as other gastrointestinal cancers. He also supervises palliative treatments such as endoscopic and percutaneous stenting of obstructed bile ducts for those patients whose cancers are advanced and not resectable.

+27 (0) 21-6716181

+27 (0)82-569-4427

1406 Netcare Christian Barnard Memorial Hospital
Cnr DF Malan Street & Rua Bartholemeu Dias Plain
Foreshore, Cape Town, 8001