ERCP (bile duct endoscopy) (Endoscopic retrograde cholangiopancreatography)

What is ERCP (bile duct endoscopy)?

ERCP stands for endoscopic retrograde cholangiopancreatography. It is a test that uses a long, bendy camera (an endoscope) passed through your mouth, down into the stomach and the first part of the small bowel. From there the doctor can see where the bile duct and pancreatic duct open, inject dye, and take X-rays to show up blockages.

Unlike an ordinary camera test, ERCP is usually done to treat something, not just to look. In the same appointment the doctor can often make a tiny cut at the duct opening (a sphincterotomy), pull out gallstones that are stuck in the bile duct, or leave a small tube (a stent) to keep a narrowed duct open.

ERCP is mostly used now for treatment rather than diagnosis, because scans such as MRCP (a type of MRI) and endoscopic ultrasound can show the ducts without any cutting or dye. Your team should be clear about why ERCP, rather than a scan, is the right step for you.

It is an effective way to clear bile duct problems without open surgery, but it carries more risk than an ordinary gastroscopy or colonoscopy, so it should be done by an experienced team and only when there is a clear reason.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

ERCP compared with MRCP scan

Doctors often use an MRCP or endoscopic ultrasound first to confirm a problem, then ERCP only if something needs treating. Ask why ERCP is being chosen for you.

Preparing for your procedure

• You will usually be asked not to eat for about 6 hours beforehand; follow the exact fasting and drinking instructions you are given.
• Tell the team about blood-thinning medicines (such as warfarin, apixaban, rivaroxaban, clopidogrel) — these often need planning around the procedure.
• Tell them if you have diabetes, heart, lung or kidney problems, a contrast (dye) allergy, or any chance you could be pregnant.
• Mention previous surgery on your stomach or bile ducts, as this can change how the ERCP is done.
• Because you will be sedated, arrange for someone to take you home and stay with you for 24 hours; you cannot drive.
• Ask whether you will be offered a suppository to lower the risk of pancreatitis, and whether you may need to stay overnight.

What happens

You will usually have sedation through a small tube in your hand or arm to make you sleepy and relaxed; some people, or more complex cases, have a general anaesthetic instead. A mouthguard protects your teeth.

Lying on your front or side, the doctor passes the endoscope through your mouth and down to where the bile and pancreatic ducts open. Dye is injected and X-rays are taken. If there is a stone or blockage, the doctor can make a small cut at the duct opening, remove stones with a balloon or basket, or leave a stent to keep the duct open.

Most ERCPs take around 30 minutes to an hour, depending on what needs doing. Afterwards you rest in a recovery area while the sedation wears off. The doctor or nurse will usually tell you what they found and did before you go home, although any biopsy results follow later.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The risk that matters most after ERCP is pancreatitis — inflammation of the pancreas — which is why ERCP is no longer used just to look. Risk is higher if the duct is hard to enter, if the pancreas is otherwise normal, or for sphincter of Oddi problems. Ask whether you will be given a rectal anti-inflammatory suppository, which lowers this risk, and make sure you know the warning signs to come back for.

Published figures to discuss

Rates vary with why the ERCP is done, how difficult the duct is to enter, and whether a cut (sphincterotomy) is made. Treatment ERCPs carry more risk than diagnostic-only tests, which is one reason scans are used first. The figures below are cautious ranges from UK patient information and society guidance, not guarantees for any one person.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no surgical wound, but you do need to recover from the sedation and let your bile system settle. Most people feel back to normal within a day or two, unless they were already unwell from the blockage.

• A sore or scratchy throat for a day or so
• Feeling bloated or windy from the air used during the test
• Feeling tired or muddled for the rest of the day after sedation
• Mild tummy discomfort that settles

Aftercare

• Have a responsible adult take you home and stay with you overnight after sedation.
• Do not drive, operate machinery, drink alcohol or make important decisions for 24 hours.
• Start with light food and drink once you feel comfortable, unless told otherwise.
• Take any new medicines (for example antibiotics) exactly as prescribed.
• Know who to contact out of hours, and go to A&E for severe pain, fever or vomiting blood.
• Keep any follow-up appointment to discuss results or arrange a stent change or gallbladder surgery.

• Someone to drive you home and stay 24 hours
• Day off work arranged (sometimes two)
• Fasting and medicine instructions understood
• Plan agreed for blood thinners
• Clinic and out-of-hours numbers saved
• Clear note of warning signs to watch for

⚠ Get urgent help if…

• Severe or worsening tummy or back pain (a possible sign of pancreatitis)
• A high temperature, shivering or feeling very unwell (a possible sign of infection)
• Vomiting blood or material that looks like coffee grounds
• Black, tarry stools or heavy bleeding from the back passage
• A hard, swollen, very tender tummy
• Yellowing of the skin or eyes that is new or getting worse
• Difficulty breathing, chest pain or fainting

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

Often the doctor can tell you straight after the test whether they found a stone or blockage and whether they cleared it or placed a stent. A successful ERCP usually means bile can drain again, so jaundice and itching improve over the following days.

ERCP does not remove the gallbladder, so if your stones came from there, more stones can form unless the gallbladder is dealt with later. Any tissue samples are read by a pathologist and discussed at a follow-up; they take several days and are needed before some diagnoses can be confirmed.

Clearing a bile duct stone usually solves that episode, but it does not stop new stones forming, especially if you still have your gallbladder. A stent is often a temporary measure and may need replacing or removing within months. Your team should explain whether you need gallbladder surgery, repeat ERCP or ongoing monitoring.

Related tests, treatments or support

ERCP is often part of a wider plan. It may follow an ultrasound, MRCP or endoscopic ultrasound that found the problem, and it is frequently followed by keyhole surgery to remove the gallbladder. In some units, ERCP and gallbladder surgery are arranged close together.

Follow-up & long-term care

You should be told who is responsible for your results, when any biopsy will be discussed, and when a stent will be checked or changed. If gallbladder surgery is recommended, you should be given a clear plan and timescale. Report jaundice, fever or pain promptly rather than waiting for a routine appointment.

• A stent placed at ERCP usually needs checking, changing or removing — keep a note of when.
• If you still have your gallbladder, follow the agreed plan for removing it to prevent further stones.
• Tell future clinicians you have had an ERCP, and whether a stent is in place.

Repeat, follow-on and what comes next

• A bile duct cannot always be cleared in one ERCP; a stent may be placed and a repeat arranged.
• Large or hard stones may need to be broken up (lithotripsy) over more than one session.
• Stents are often temporary and planned for replacement or removal.
• If ERCP repeatedly fails, surgery or drainage through the skin may be needed.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• Clear written warning signs and a named out-of-hours contact, with A&E advice for severe pain or fever.
• A defined plan for who gives you your results and when any biopsy is discussed.
• Arrangements for any stent change or removal, written down.
• A plan for gallbladder surgery if your stones came from the gallbladder.
• Monitoring after the test for early signs of pancreatitis before you are discharged.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• Whether sedation or a general anaesthetic is used, and the anaesthetist's involvement
• What is done during the test (sphincterotomy, stone removal, stent, biopsy)
• The endoscopist's fee and the facility or theatre charge
• Any X-ray and contrast dye used
• Whether you need an overnight stay because you are unwell or to watch for pancreatitis
• Follow-up appointments, a later stent change, or gallbladder surgery

• The endoscopist's fee and the facility/day-case fee
• Sedation or anaesthetist fees
• Cost of any stent or other device used
• Biopsy/pathology and reporting fees
• What happens (and what it costs) if the duct cannot be cleared and a repeat is needed
• Cost of any overnight stay if a complication occurs
• Follow-up consultation to discuss results

On the NHS? ERCP is routinely available on the NHS when there is a stone or blockage; private care may be chosen for speed or convenience, but this is treatment rather than an elective procedure.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• Why is ERCP the right step for me rather than a scan such as MRCP?
• How many ERCPs does this unit and this doctor do each year?
• What will you do if you cannot clear my bile duct in one go?
• Will I be given a suppository to lower the risk of pancreatitis?
• Will I need my gallbladder removed afterwards, and when?
• What exactly should make me come back urgently?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for ercp (bile duct endoscopy)

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Gallstones: treatment BSG — ERCP Quality Improvement Programme NICE CG188 — Gallstone disease recommendations JAG/BSG — UK ERCP sedation practice (NED analysis, PMC) NHS (Hull) — ERCP patient leaflet

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.