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Special Procedures

Summa Health’s digestive team specializes in diagnosing and treating a variety of disorders through advanced, minimally invasive endoscopic procedures. Two such procedures include using endoscopic retrograde cholangiopancreaticography (ERCP) to perform endoscopic therapy of bile duct stones, as well using endoscopic ultrasound, EUS-guided fine-needle aspiration and biopsy for endoscopic staging of gastrointestinal and biliary cancers.

Endoscopic Retrograde CholangioPancreatography (ERCP)

ERCP is most commonly used in response to abdominal pain suggestive of gallstones, jaundice and pancreatitis. It allows your physician to view your pancreatic and bile ducts, which are small tubes near your stomach that carry digestive juices from your liver and pancreas to the intestines.

What is ERCP

ERCP is a combination of an endoscopy and an X-ray evaluation of the bile ducts and the pancreatic duct. During the procedure, a gastroenterologist inserts a flexible lighted tube with a camera on the end – called an endoscope – through your mouth into your stomach and the first part of the small intestine, called the “duodenum.” Your doctor then puts a very small, flexible plastic tube (a tiny catheter) through the scope and injects a contrast agent, or dye. The dye shows up on the X-rays and allows your doctor to see the ducts and how well they are functioning.

Preparing for ERCP

You should not have anything to eat or drink for about 6 hours before the test. A local anesthesia and intravenous sedative eliminates any sensation of gagging. But because sedation is given, a designated driver is necessary to take you home after the procedure. 

The actual procedure lasts between 30 and 45 minutes. Generally, patients do not feel or remember anything. The endoscope does not affect your breathing, and you might even fall asleep during the procedure. If you do feel discomfort, it will likely be minor. If pancreatitis occurs, the pain does not usually start until 4 hours after the procedure. Intravenous antibiotics may be required if there are risk factors for infection of the heart valves. For a number of conditions, the patient may stay overnight for observation.

Treatment Performed During ERCP

Once the source of the problem is identified, you gastroenterologist may treat it by performing a sphincterotomy. A sphincterotomy involves making a small incision in the opening of the pancreatic or bile duct, which can help small gallstones, bile, and pancreatic juice to drain appropriately. If malignant obstruction of the ducts is seen, a plastic or expandable metallic stent (hollow tube) can be placed to hold the duct open and allow it to drain.

Risks of ERCP

The risks of injecting a contrast agent into the ducts are infection and pancreatitis. The risks of sphincterotomy are bleeding and perforation. Discuss any concerns with your physician prior to the procedure.

Endoscopic Ultrasound (EUS)

EUS, a minimally invasive procedure, allows for very detailed imaging and analysis needed to assess gastrointestinal and lung disease. It involves a thin, flexible tube – called an endoscope – that has a built-in miniature ultrasound probe. The probe emits high-frequency sound waves to produce images of the lining and walls of a patient’s digestive tract and chest. It can also capture images of nearby organs such as the pancreas and liver, and lymph nodes.

Combined with fine-needle aspiration (FNA), EUS is a minimally invasive alternative to exploratory surgery. It allows your physician to collect tissue samples, which can later be analyzed under a microscope. FNA is most commonly performed to evaluate masses or tumors, in order to determine if cancer is present.

Find a ERCP/EUS Specialist

Amin Mahdi, M.D., is a Summa Health gastrointestinal surgeon with special interests in Gastroenterology, Hepatology, Advanced Endoscopy and ERCP/EUS. Appointments with Dr. Mahdi are by physician referral only. For more information, visit or call 330.253.1800.


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