Definition & Overview

A biliary tract endoscopy is a diagnostic and therapeutic medical procedure that allows doctors to take a look inside the stomach and down to the biliary tree to diagnose and treat diseases of the biliary tract and its associated organ, namely the liver, gallbladder, and pancreas. It is also known as endoscopic retrograde cholangiopancreatography (ERCP) or simply biliary endoscopy.

Who Should Undergo and Expected Results

Biliary tract endoscopy is recommended for patients who suffer from or are suspected of having a medical problem involving the biliary tract and its nearby organs, such as:

  • Gallstones – These are small and hard crystalline masses that form in the gallbladder or along the bile ducts, causing pain and obstruction. They form due to bile pigments, calcium salts, and cholesterol.

  • Inflammatory biliary strictures – These refer to abnormally narrowed parts of the bile duct and they can either be benign or malignant. Although uncommon, they are serious problems that may sometimes lead to life-threatening emergencies.

  • Cancer – Abnormal tissue growths along the bile duct and the organs connected to it can be symptoms of various types of cancer, such as pancreatic cancer or cholangiocarcinoma (bile duct cancer).

  • Choledochocele – This is a rare disorder characterized by acute pancreatitis, jaundice, and biliary colic.

  • Cholecystitis – This refers to an infection and inflammation of the gallbladder.

  • Biliary colic – This occurs when a gallstone obstructs the cystic duct and causes the gallbladder to contract painfully.

  • Bile duct leakage – The bile duct can be injured due to trauma and surgery resulting in leakage.

A biliary tract endoscopy is highly useful for diagnosing the above conditions and any other conditions associated with the narrowing of or any obstruction in the common bile duct. Studies show that it is more effective in diagnosing pancreatic cancer compared to a CT scan.

While the procedure is primarily used for diagnostic purposes, it can also be used for treatment. For example, if the doctor detects an obstruction during a biliary endoscopy, special surgical instruments can be inserted through the endoscope to remove the obstruction.

How is the Procedure Performed?

A biliary tract endoscopy is performed in an room of a hospital as it requires special x-ray equipment. The whole procedure can take as little as 30 minutes or as long as two hours, depending on the findings and whether treatment will also be attempted or performed. To ensure safety and accuracy, patients are instructed to refrain from eating or drinking anything after midnight on the day before the procedure is scheduled.

During the procedure itself, patients are asked to lie on their left side on an exam table and are given numbing medication through the back of the throat. This numbs the throat area and allows the doctor to insert an endoscope through the mouth, down the esophagus, and all the way down to the biliary tract where the bile ducts open into the duodenum. Most patients experience slight discomfort when swallowing the endoscope, which is a thin tube with a tiny camera and scope attached to its end.

Once the endoscope has reached the target point, the patient is asked to lie on the stomach. The physician will then pass a small plastic tube into the endoscope and a dye material is injected. This material will make its way through the ducts, highlighting the entire biliary tree on the images captured by the endoscopic camera. Once the dye has been injected, the doctor proceeds to take x-ray images so they can be later reviewed for further analysis.

If necessary, a biliary endoscopy can also be used to take a biopsy of the bile ducts. This involves taking a piece of tissue from the bile ducts so that it can be examined under the microscope for any abnormalities.

After a purely diagnostic biliary endoscopy, patients are usually advised to stay in the hospital for a couple of hours or until the effects of the sedatives subside. During this time, they are placed under observation to watch out for signs of any complication. However, if the endoscopy is used to treat a problem, such as when a gallstone is detected and also removed during the same procedure, the patient will be asked to stay in the hospital overnight.

It is normal for patients to experience some tenderness at the site where the sedative or numbing medication was injected. However, this discomfort or soreness is expected to pass within a couple of days without treatment.

Possible Risks and Complications

Like most medical procedures, a biliary endoscopy comes with some risks and possible complications. In this case, these complications, although uncommon, may take the form of:

  • Pancreatitis, or inflammation of the pancreas
  • Infection
  • Bleeding
  • Perforated duodenum
  • Allergic reaction to the sedatives
  • Allergic reaction to the dye material or iodine


  • Dadhwal US., Kumar V. (2012). “Benign bile duct strictures.” Med J Armed Forces India. 2012 Jul; 68(3):299-303.

  • Collins D., Carbonella G., Herr A., et al. (2015). “Biliary endoscopy: an opportunity for interventional radiology.” Journal of Vascular and Interventional Radiology.

  • Freeman M., Nelson D., Sherman S. (1996). “Complications of endoscopic biliary sphincterectomy.” The New England Journal of Medicine.

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