Preparation: The patient is usually sedated or put under local anesthesia to ensure comfort. In some cases, general anesthesia may be used. The patient must fast for several hours before the procedure.

Insertion of the Endoscope: The doctor inserts the endoscope through the mouth and navigates it through the esophagus, stomach, and into the duodenum to locate the opening (ampulla of Vater) where the bile and pancreatic ducts meet.

Injection of Contrast Dye: The physician injects contrast dye through the endoscope into the bile and pancreatic ducts. This allows the doctor to visualize the ducts on the X-ray monitor.

X-Ray Imaging: Fluoroscopy is used to guide the doctor in identifying any abnormalities such as stones, tumors, strictures (narrowing of ducts), or other issues.

Therapeutic Interventions (if necessary):

• Stone Removal: If stones are found in the bile or pancreatic ducts, they may be removed during the procedure using special tools passed through the endoscope.
• Stent Placement: In cases of duct blockage, a stent (a small tube) may be placed in the bile or pancreatic duct to keep it open.
• Biopsy: If a suspicious mass is detected, a biopsy may be performed to take tissue samples for further analysis.
• Dilation: For strictures, the duct may be dilated using a balloon or other instruments.
• Sphincterotomy: If there is a blockage at the ampulla (where the bile and pancreatic ducts empty into the duodenum), a small incision may be made to relieve the obstruction.