ERCP in Hong Kong

When ERCP may be used

The endoscope passes through the mouth into the duodenum, where the doctor can identify the small duct openings and pass fine instruments into them. ERCP is generally considered when there is a likely problem that may need treatment, such as a bile-duct stone, a blockage or narrowing, or a need to place or exchange a drainage stent. It may allow the doctor to remove a stone, take a sample, widen an opening or place a stent in the same session. If the main need is to look for a problem without treating it, ultrasound, CT or MRI/MRCP may provide useful information with less procedural risk; your doctor will weigh the options for your case.

Benefits, risks and limitations

ERCP is a therapeutic procedure, not a routine diagnostic gastroscopy, and the intended steps can change according to what is found. It usually involves sedation or anaesthesia and X-rays. Risks include pancreatitis, bleeding, infection of the bile ducts and, rarely, a tear or perforation; complications can require additional treatment or a longer hospital stay, and very rarely can be serious. Risk varies with the reason for ERCP, the intervention performed and personal health factors. A stent may need later review or removal, and a single procedure does not always resolve the underlying problem. Before proceeding, the doctor should explain the expected benefit, alternatives, possible complications and what is planned if the duct cannot be treated as intended.

Preparation and follow-up

In Dr Ng’s practice, ERCP is arranged only in hospital, as a day admission or an overnight stay, not at an outpatient centre. The hospital setting allows assessment and observation appropriate to the planned procedure, but does not remove all risks. Before the procedure, tell the team about all medicines (especially anticoagulants or antiplatelet drugs), allergies, diabetes, heart or lung conditions, pregnancy possibility, previous ERCP or anaesthetic problems, and any relevant test results. Do not stop medicines or follow a general fasting schedule without your own instructions: the timing, sedation plan, need for an escort and whether you stay overnight are decided after assessment. The team will explain recovery, diet and medicine advice, follow-up for any stent, and whom to contact if concerns arise after discharge. During ERCP, contrast is introduced into the duct openings so they can be seen on X-ray; the doctor may need to make a small cut in the duct opening to remove a stone or improve drainage. Sometimes the anatomy, narrowing or inflammation makes access difficult, and the intended treatment may be incomplete or need another procedure. Ask beforehand which outcomes are most likely in your case and whether a stent would be temporary or require planned follow-up. The hospital team monitors you as sedation wears off and decides when discharge is appropriate; an overnight stay is not automatic and depends on findings and recovery. Follow the written discharge plan, including advice about eating, medicines and the stent. Contact the hospital team promptly if you develop concerning symptoms such as increasing abdominal pain, fever, repeated vomiting, black stools or bleeding after discharge; they will tell you whether urgent assessment is needed. The procedure uses X-rays, so tell the team if pregnancy is possible.

Understanding your results

If a duct is treated or a stent is placed, confirm what was done and who is responsible for checking, exchanging or removing the stent. Symptoms and blood tests may still need follow-up after the procedure. Ask whom to contact promptly if abdominal pain, fever or jaundice develops.

Professional references

• ASGE · ERCP