ERCP — What to Expect, and Why It Matters Before Surgery
5 June 2026 · 4 min read
Endoscopic retrograde cholangiopancreatography is often done before gallbladder surgery to clear stones from the bile duct. Here is what that day looks like, and the risks worth knowing.
What ERCP is
ERCP — endoscopic retrograde cholangiopancreatography — uses a side-viewing endoscope passed through the mouth into the duodenum to access the bile and pancreatic ducts. It is both diagnostic and therapeutic.
In hepatobiliary practice, the most common reason we recommend it is choledocholithiasis — gallstones that have migrated into the common bile duct. Clearing those stones endoscopically first means the subsequent laparoscopic cholecystectomy is straightforward.
On the day of the procedure
You arrive fasting. Sedation is given through a small IV. The procedure itself takes 30–60 minutes. We pass the scope, identify the papilla, cannulate the bile duct, image it with contrast, and extract any stones we find. Most patients go home the same day or the next morning.
Risks, and how we manage them
Risks are small but real — pancreatitis (3–5%), bleeding, perforation. We pre-empt pancreatitis with rectal NSAIDs in the recovery room and IV fluids overnight.
The decision to do ERCP first vs an intra-operative cholangiogram comes down to the size of the stones, the size of the duct, and available equipment. In a teaching hospital with a 24/7 endoscopy unit, ERCP first is usually our default.
Consult Dr. Kazi Mazharul Islam
For a hepatobiliary, pancreatic or laparoscopic surgical opinion at chambers in Dhaka or Brahmanbaria.