The nurse is preparing a patient for a magnetic resonance cholangiopancreatography

About the Scan – Cholangiopancreatography (MRCP)

Magnetic resonance cholangiopancreatography (MRCP) is a special type of MRI exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.

SMIL radiologists use MRCP to:

• examine diseases of the liver, gallbladder, bile ducts, pancreas and pancreatic duct. These may include tumors, stones, inflammation or infection.
• evaluate patients with pancreatitis to detect the underlying cause.
• help to diagnose unexplained abdominal pain.
• provide a less invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). ERCP is a diagnostic procedure that combines endoscopy, which uses an illuminated optical instrument to examine inside the body, with iodinated contrast injection and x-ray images.

During the scan, you will be positioned on the moveable examination table. Devices that contain coils capable of sending and receiving radio waves may be placed around or adjacent to the area of the body being studied.

If a contrast material will be used in the MRI exam, a nurse or technologist will insert an intravenous (IV) catheter, also known as an IV line, into a vein in your hand or arm. A saline solution may be used. The solution will drip through the IV to prevent blockage of the IV catheter until the contrast material is injected.

You will be moved into the magnet of the MRI unit and the radiologist and technologist will leave the room while the MRI examination is performed.

If a contrast material is used during the examination, it will be injected into the intravenous line (IV) after an initial series of scans. Additional series of images will be taken during or following the injection.

The actual MRCP exam takes about 10 minutes, but it is often performed with a standard MRI of the abdomen, which may last approximately 30 minutes and involve the use of a contrast material. In this case, the entire examination is usually completed within 45 minutes.

Learn how to prepare for the scan in the Cholangiopancreatography preparations section.

Find out if this procedure is right for you in the benefits and risks of Cholangiopancreatography section.

For a downloadable/printable PDF about this exam with preparation instructions click here.

On this page:

• What is ERCP?
• What are the bile and pancreatic ducts?
• Why do doctors use ERCP?
• How do I prepare for ERCP?
• How do doctors perform ERCP?
• What should I expect after ERCP?
• What are the risks of ERCP?
• Seek care right away

What is ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that combines upper gastrointestinal (GI) endoscopy and x-rays to treat problems of the bile and pancreatic ducts.

What are the bile and pancreatic ducts?

Your bile ducts are tubes that carry bile from your liver to your gallbladder and duodenum. Your pancreatic ducts are tubes that carry pancreatic juice from your pancreas to your duodenum. Small pancreatic ducts empty into the main pancreatic duct. Your common bile duct and main pancreatic duct join before emptying into your duodenum.

Why do doctors use ERCP?

Doctors use ERCP to treat problems of the bile and pancreatic ducts. Doctors also use ERCP to diagnose problems of the bile and pancreatic ducts if they expect to treat problems during the procedure. For diagnosis alone, doctors may use noninvasive tests—tests that do not physically enter the body—instead of ERCP. Noninvasive tests such as magnetic resonance cholangiopancreatography (MRCP)—a type of magnetic resonance imaging (MRI)—are safer and can also diagnose many problems of the bile and pancreatic ducts.

Doctors perform ERCP when your bile or pancreatic ducts have become narrowed or blocked because of

• gallstones that form in your gallbladder and become stuck in your common bile duct
• infection
• acute pancreatitis
• chronic pancreatitis
• trauma or surgical complications in your bile or pancreatic ducts
• pancreatic pseudocysts
• tumors or cancers of the bile ducts
• tumors or cancers of the pancreas

How do I prepare for ERCP?

To prepare for ERCP, talk with your doctor, arrange for a ride home, and follow your doctor’s instructions.

Talk with your doctor

You should talk with your doctor about any allergies and medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

• arthritis medicines
• aspirin or medicines that contain aspirin
• blood thinners
• blood pressure medicines
• diabetes medicines
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen

Your doctor may ask you to temporarily stop taking medicines that affect blood clotting or interact with sedatives. You typically receive sedatives during ERCP to help you relax and stay comfortable.

Tell your doctor if you are, or may be, pregnant. If you are pregnant and need ERCP to treat a problem, the doctor performing the procedure may make changes to protect the fetus from x-rays. Research has found that ERCP is generally safe during pregnancy.1

Arrange for a ride home

For safety reasons, you can’t drive for 24 hours after ERCP, as the sedatives or anesthesia used during the procedure needs time to wear off. You will need to make plans for getting a ride home after ERCP.

Don’t eat, drink, smoke, or chew gum

To see your upper GI tract clearly, you doctor will most likely ask you not to eat, drink, smoke, or chew gum during the 8 hours before ERCP.

How do doctors perform ERCP?

Doctors who have specialized training in ERCP perform this procedure at a hospital or an outpatient center. An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. A health care professional will give you a liquid anesthetic to gargle or will spray anesthetic on the back of your throat. The anesthetic numbs your throat and helps prevent gagging during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible. In some cases, you may receive general anesthesia.

You’ll be asked to lie on an examination table. The doctor will carefully feed the endoscope down your esophagus, through your stomach, and into your duodenum. A small camera mounted on the endoscope will send a video image to a monitor. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During ERCP, the doctor

• locates the opening where the bile and pancreatic ducts empty into the duodenum
• slides a thin, flexible tube called a catheter through the endoscope and into the ducts
• injects a special dye, also called contrast medium, into the ducts through the catheter to make the ducts more visible on x-rays
• uses a type of x-ray imaging, called fluoroscopy, to examine the ducts and look for narrowed areas or blockages

The doctor may pass tiny tools through the endoscope to

• open blocked or narrowed ducts.
• break up or remove stones.
• perform a biopsy or remove tumors in the ducts.
• insert stents—tiny tubes that a doctor leaves in narrowed ducts to hold them open. A doctor may also insert temporary stents to stop bile leaks that can occur after gallbladder surgery.

The procedure most often takes between 1 and 2 hours.

What should I expect after ERCP?

After ERCP, you can expect the following:

• You will most often stay at the hospital or outpatient center for 1 to 2 hours after the procedure so the sedation or anesthesia can wear off. In some cases, you may need to stay overnight in the hospital after ERCP.
• You may have bloating or nausea for a short time after the procedure.
• You may have a sore throat for 1 to 2 days.
• You can go back to a normal diet once your swallowing has returned to normal.
• You should rest at home for the remainder of the day.

Following the procedure, you—or a friend or family member who is with you if you’re still groggy—will receive instructions on how to care for yourself after the procedure. You should follow all instructions.

Some results from ERCP are available right away after the procedure. After the sedative has worn off, the doctor will share results with you or, if you choose, with your friend or family member.

If the doctor performed a biopsy, a pathologist will examine the biopsy tissue. Biopsy results take a few days or longer to come back.

What are the risks of ERCP?

The risks of ERCP include complications such as the following:

• pancreatitis
• infection of the bile ducts or gallbladder
• excessive bleeding, called hemorrhage
• an abnormal reaction to the sedative, including respiratory or cardiac problems
• perforation in the bile or pancreatic ducts, or in the duodenum near the opening where the bile and pancreatic ducts empty into it
• tissue damage from x-ray exposure
• death, although this complication is rare

Research has found that these complications occur in about 5 to 10 percent of ERCP procedures.2 People with complications often need treatment at a hospital.

References

Which enzyme is responsible for the release of vasoactive peptides?

Which of the following factors may be associated with the development of cholelithiasis select all that apply?

Which scan will provide the most reliable diagnosis of acute pancreatitis?

Which medication would be administered after extracorporeal shock wave lithotripsy for treatment of cholelithiasis?