Combining endoscopy,( the examination of an internal body part with an instrument called an endoscope), and x-rays has become one of the most effective ways to diagnose and treat hepatobiliary disease, bile duct blockages, tissue abnormalities, and even tumors in the bile ducts. The technique is called Endoscopic Retrograde Cholangiopancreatography (ERCP). If a problem is found during ERCP, the endoscopist can often perform a procedure to repair or improve the condition. Many ERCP patients are hospitalized, but ERCP has replaced surgery in most patients with common bile duct and pancreatic disease, and depending on the patient’s condition and the complexity of the procedure, ERCP can also be performed as an outpatient procedure.

Although many people worry about discomfort from the endoscopy, most tolerate it well and feel fine afterwards. Medications are given through an IV line during the procedure. A plastic mouth guard is placed between the teeth to prevent damage to the teeth and endoscope. Many patients sleep during the test; others are very relaxed and are not aware of the examination.

The ERCP endoscope is a special flexible tube, approximately the size of a finger. It contains a lens and a light source that allows the endoscopist to view the inside of the patient’s body; images are magnified on a monitor so that even very small details and changes can be seen. The endoscope also contains channels that allow the endoscopist to take biopsies (painless tissue samples) and introduce or withdraw fluid, air, or other instruments. Contrast medium is introduced and seen through use of x-rays. Depending on what the endoscopist sees during the ERCP, he may perform a variety of procedures or treatments. The length of the examination varies between 30 and 90 minutes (usually about an hour).

During his residency and fellowship, Dr. Johnson trained in Surgical Endoscopy with a specific emphasis on both diagnostic & therapeutic ERCP.  In fact, along with other colleagues, he developed a new method for treating obstructing complicated biliary disease using combined cholecystectomy and ERCP in a one stage procedure, so-called the “One-Step/ELBS.”  Throughout residency and fellowship, Dr. Johnson presented at many national conferences regarding ERCP use by surgeons for trauma and general surgery in addition to authoring several publications.

For more information on ERCP go to: http://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/ercp/Pages/diagnostic-test.aspx#Remember