ERCP & Bile Duct Treatment in Edinburgh

Bile duct stones, blockages and jaundice — investigated and treated by one consultant who performs both the endoscopy and the surgery.

4.98/5 from 149+ verified patient reviews

• Consultant-performed ERCP with independently-audited success rates consistently above 94%
• Day-case procedure, typically around 30 minutes, under conscious sedation — home the same day or following morning
• Fee-assured with all major insurers

When ERCP is needed

ERCP (endoscopic retrograde cholangiopancreatography) is an advanced endoscopic technique for reaching the bile duct — the tube that carries bile from the liver to the intestine — without an operation. It is most often recommended when a scan (ultrasound, CT or MRCP) has shown stones in the bile duct, or a narrowing that is blocking the flow of bile.

Typical situations include:

• Gallstones that have escaped into the bile duct — before, during or after gallbladder surgery
• Jaundice: yellowing of the skin or eyes, dark urine and pale stools, caused by a blocked duct
• Bile duct narrowing (stricture) needing a stent to restore drainage
• Gallstone pancreatitis, where a stone blocking the duct has inflamed the pancreas

In gallstone disease there are genuine pros and cons between ERCP and surgery, and the right answer is patient-specific. That judgement is easiest to make well when the person advising you performs both — which is the basis of my practice.

Why one consultant for scan, endoscopy and surgery

In many hospitals, a patient with bile duct stones is passed between a gastroenterologist for the ERCP and a surgeon for the gallbladder — two clinicians, two waiting lists, two conversations. I perform both procedures, which means:

• One assessment, one coordinated plan, one point of contact
• The ERCP-versus-surgery decision made by someone with no professional stake in either answer
• Where both are needed, they are co-ordinated seamlessly — no delays with referrals between specialists
• Occasionally ERCP is not technically possible (this is uncommon — success rates in my audited practice are consistently above 94%). If this proves to be the case, I will arrange an appropriate alternative approach (e.g. surgery, or a combined procedure with surgery and endoscopy at the same time)

What the procedure involves

ERCP typically takes around 30 minutes and is performed as a day case: home the same day, or occasionally the following morning.

Beforehand. Nothing to eat for six hours; small sips of water permitted until two hours before. If you take blood-thinning medication (warfarin, clopidogrel or similar), tell the team well in advance — it usually needs to be paused for some days. Routine blood tests are arranged before the procedure.

Sedation, not general anaesthetic. You receive a local anaesthetic throat spray and intravenous sedation — deeper than that used for a routine endoscopy, such that most patients remember very little afterwards. There is plenty of room to breathe around the scope, and your oxygen levels and heart rate are monitored throughout. Most patients drift off within about a minute of the scope being positioned.

The procedure itself. The endoscope is passed gently through the mouth to the duodenum (the first part of the small bowel after the stomach). A small cannula is placed into the bile duct where it joins the duodenum and contrast dye and X-ray imaging (a cholangiogram) are then used to map the duct. A small, painless cut is made in the duct's valve muscle (sphincterotomy) to facilitate removal of stones from the duct or treatment of a narrowing with a stent or balloon dilatation. A protective anti-inflammatory (diclofenac) is given during the procedure, which has been proven to reduce the risk of pancreatitis afterwards.

Afterwards

• Around an hour in recovery while the sedation wears off, then fluids and light food
• A responsible adult must take you home and stay with you for 24 hours
• For 24 hours: no driving, machinery, alcohol, legal documents or important decisions
• Most patients return to work within a day or two
• Mild bloating or abdominal discomfort for a day or so is normal; results are discussed with you before you leave, and a report goes to your GP and referring doctor

Seek help promptly for severe abdominal pain, fever, new jaundice, or any suggestion of bleeding — you will go home with direct contact details and clear instructions.

Risks

ERCP is a specialised procedure and, alongside its effectiveness, does carry the risk of significant complications which need clear explanation:

• Sore throat and temporary bloating: common and short-lived
• Pancreatitis: the most significant risk — around 5% depending on individual factors; most cases are mild and settle within days. Preventative diclofenac is given routinely. If post-ERCP pancreatitis does occur, 9 times out of 10 it is mild, which means no specific additional treatment is required, but a longer stay in hospital may be required until the inflammation settles. 10% of post-ERCP pancreatitis (0.5% of all procedures) can be severe.
• Bleeding after sphincterotomy: 1%; usually stops on its own, but can require reintervention or transfusion
• Bile duct infection (cholangitis): 1–2%; antibiotics are given where risk is raised
• Perforation: 1%; may require surgical repair
• Rare, serious events (heart attack, stroke, death): under 1 in 200 procedures overall and concentrated in patients with serious underlying illness. Individual risk is assessed and discussed comprehensively at consultation

Where ERCP cannot be completed — uncommon, and usually anatomical — the alternatives (repeat ERCP, a combined surgical-endoscopic approach, or surgery) are discussed with you by the same consultant.

Alternatives

• MRCP: an MRI of the ducts — excellent pictures, no risk, but purely diagnostic; it cannot remove a stone or place a stent
• Endoscopic ultrasound (EUS): similarly diagnostic, often with even better resolution than MRI — this can be helpful if MRI is equivocal, or if symptoms and blood tests have improved, suggesting that a stone may have passed through to the duodenum by itself. EUS can be performed immediately before a planned ERCP if needed (only proceeding to intervention with ERCP if the presence of a stone is confirmed).
• Surgery: bile duct exploration at the time of gallbladder removal — in some circumstances this can be a better option (patient-specific, discussed at the time of consultation). Bile duct exploration essentially avoids the risk of pancreatitis, but can carry other risks such as bile leak or bile duct narrowing.

Frequently asked questions

Is ERCP painful? No — over 90% of ERCPs are performed as a day-case procedure under sedation and most patients remember little. Some bloating afterwards is common and short-lived.

How quickly can it be arranged? Timing of ERCP is prioritised for clinical need (for example, the presence of jaundice or infection). Routine elective ERCP is typically completed within 4–6 weeks from referral.

How much does it cost? Fee-assured with all major insurers.

Who will actually do my procedure? I will arrange and perform your ERCP, then undertake gallbladder surgery if required (or liaise with the consultant surgeon who has referred you to me for specialist input). Consultant-performed, start to finish.

Written by Mr Chris Johnston MBBS BSc(Hons) PhD FRCS FRCP, Consultant Transplant & General Surgeon and advanced endoscopist, Royal Infirmary of Edinburgh. GMC 6163920. ORCID 0000-0001-9935-7365. Last clinically reviewed: 13 August 2026.

Jaundice, duct stones, or a scan you'd like explained?

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