ADVANCED BILIARY ENDOSCOPY & SURGICAL CARE · EDINBURGH
4.98/5 FROM 149+ VERIFIED PATIENT REVIEWS · DOCTIFY OUTSTANDING PATIENT EXPERIENCE
Consultant Endoscopist & Hepatobiliary Surgeon
Spire Murrayfield Hospital & Shawfair Park
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.
INSURER ACCREDITED
Fee-assured
Recognized and fee-assured with all major
UK private health insurers (Bupa, AXA Health,
Aviva, Vitality, WPA).
AUDITED CLINICAL PRECISION
>94%
Consistently above 94% independently-audited success rates across complex therapeutic interventions.
DAY-CASE PROCEDURE
~30 Mins
Under conscious sedation — home the same
day or following morning with minimal post-
operative downtime.
CLINICAL INDICATIOn
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 open operation. It is most often recommended when an imaging scan (ultrasound, CT, or MRCP) demonstrates calculi within the biliary tree, or a stricture causing biliary obstruction.
When ERCP is needed
INDICATION 01
Choledocholithiasis
Gallstones that have escaped into the bile duct — diagnosed before, during, or remaining after gallbladder surgery.
Duct stone clearance
INDICATION 02
Obstructive Jaundice
Yellowing of the skin or sclera, dark urine, and pale stools caused by mechanical blockage of the common bile duct.
Urgent decompression
INDICATION 03
Biliary Stricture
Bile duct narrowing requiring balloon dilatation or precision endoprosthesis (stent) placement to restore unobstructed drainage.
Stent restoration
INDICATION 04
Gallstone Pancreatitis
Acute inflammation of the pancreas triggered by an impacted stone at the ampulla, requiring prompt therapeutic extraction.
Ampullary relief
THE BALANCED CLINICAL PERSPECTIVE
"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."
— MR CHRIS JOHNSTON, CONSULTANT TRANSPLANT & GENERAL SURGEON, ADVANCED ENDOSCOPIST
CONTINUITY OF CARE
Why one consultant for scan, endoscopy and surgery
Eliminating fragmented clinical pathways, dual waiting lists, and conflicting medical opinions.
THE CONVENTIONAL HOSPITAL MODEL
"In many hospitals, a patient is passed between a gastroenterologist for ERCP and a surgeon for the gallbladder — two clinicians, two waiting lists, two conversations."
This traditional bifurcation often results in delayed inter-specialty referrals, duplicated radiological evaluations, and prolonged discomfort for patients caught between competing departmental priorities.
THE EDINBURGH COMBINED PRACTICE MODEL
As a dual-trained consultant who performs both complex endoscopic retrograde cholangiopancreatography and laparoscopic hepatobiliary surgery, your diagnostic review, endoscopic duct clearance, and surgical management are unified into a singular clinical pathway.
One Coordinated Plan
One continuous assessment, one point of contact, and zero administrative handoffs.
Zero Inter-Referral Delays
Where both ERCP and cholecystectomy are
needed, scheduling is seamlessly aligned.
Unbiased Clinical Choice
The ERCP-versus-surgery decision is made with zero procedural bias or professional stake.
Integrated Alternative Safety
Immediate transition to surgical bile duct exploration if anatomical variations preclude ERCP.
SURGICAL PRECISION & TECHNIQUE
ERCP typically takes around 30 minutes and is performed as a day case: home the same day, or occasionally the following morning.
What the procedure involves
PHASE 01
Beforehand
Nothing to eat for six hours before your admission; small sips of water are permitted until two hours before. If you take anticoagulant or antiplatelet medication (such as warfarin, clopidogrel, rivaroxaban or similar), please inform the team in advance — pausing is required under managed haematological protocol. Routine pre-procedure blood panels (FBC, clotting, LFTs) are checked in advance.
• 6H FASTING
• WATER UP TO 2H
• ANTICOAGULANT REVIEW
PHASE 02
Sedation, not general anaesthetic
You receive a local anaesthetic throat spray and target-controlled intravenous sedation — administered deeper than routine gastroscopy so that patients remain deeply comfortable and remember very little afterwards. There is ample room to breathe naturally around the scope, and blood oxygenation and cardiac rhythm are continuously monitored. Most patients drift off within a minute of scope positioning.
• CONSCIOUS IV SEDATION
• CONTINUOUS SPO2 MONITORING
• NATURAL AIRWAY
PHASE 03
The procedure itself
The side-viewing duodenoscope is guided smoothly through the stomach into the duodenum. A fine cannula is introduced into the ampulla of Vater where the common bile duct enters the bowel. Radiopaque contrast is gently instilled under live fluoroscopic X-ray imaging (cholangiogram) to delineate duct anatomy and calculus location. A precise, painless microscopic division of the muscular sphincter (sphincterotomy) facilitates basket or balloon clearance of stones, or insertion of a drainage stent.
Protective Protocol: A preventative anti-inflammatory dose (diclofenac) is administered duringс ERCP, clinical practice rigorously proven in trials to dramatically suppress post-procedure pancreatitis risk.
ANATOMICAL ARCHITECTURE
Biliary & Pancreatic Ducts
Duodenl Ampulla:
Point of endoscopic cannulation and therapeutic sphincterotomy.
Common Bile Duct:
Direct extraction of stones or placement of self-expanding stent.
POST-OPERATIVE PATHWAY
Recovery & what to expect afterwards
A structured, monitored transition from the endoscopy recovery suite to restful recuperation at home.
1 Hour
RECOVERY WARD
Close clinical monitoring in the recovery suite while the sedation naturally wears off, followed by light clear fluids and tea.
Escort
HOME COMPANION
A responsible adult companion must accompany you home by car or taxi and remain with you for the initial 24-hour period.
24 Hours
RESTRICTIONS
Strictly no driving, operating machinery, drinking alcohol, signing legal contracts, or making significant decisions.
1–2 Days
RETURN TO ROUTINE
Most patients return comfortably to sedentary office work within 24 to 48 hours. Comprehensive results are explained before discharge.
Typical Post-Procedure Sensations
Mild bloating, minor wind discomfort, or a slight scratchy throat for a day or two is
entirely normal due to the air introduced during endoscopy. Comprehensive written procedure notes and biopsy reports are sent directly to your GP and referring physician.
Direct post-operative follow-up appointment arranged prior to leaving the clinic
SEEK HELP PROMPTLY
Contact the direct clinical team immediately if you experience severe persistent abdominal pain, fever or shivering, worsening jaundice (yellow eyes/skin), or any sign of black stools/bleeding.
Direct emergency clinical ward telephone number provided at discharge
OPEN GOVERNANCE & SAFETY
ERCP is a specialised procedure and, alongside its proven therapeutic efficacy, carries specific potential complications that require clear, unvarnished explanation before consent.
Risks, plainly stated
COMMON & TRANSIENT
Throat & Bloating
Common
Mild pharyngeal irritation and temporary trapped wind from bowel insufflation; resolves naturally
within 24 to 48 hours.
PRIMARY CLINICAL RISK
Post-ERCP Pancreatitis
~5%
Preventative diclofenac is routinely administered. 9 out of 10 cases are mild requiring only inpatient fluid support. Severe pancreatitis occurs in ~0.5% of cases.
SPHINCTEROTOMY
Bleeding
~1%
Bleeding from the microscopic cut into the duct sphincter. The vast majority halts spontaneously; rarely requires endoscopic clipping or transfusion.
BACTERIAL INFECTION
Cholangitis
1–2%
Infection of the stagnant bile within the duct.
Prophylactic targeted intravenous antibiotics are administered whenever duct drainage may be partially obstructed.
STRUCTURAL WALL DEFECT
Perforation
~1%
Puncture of the duodenal wall or duct lumen.
Managed with conservative antibiotics and
decompression or, where indicated, prompt surgical repair.
GENERAL & CARDIAC
Serious Systemic Events
<1 in 200
Major cardiovascular or respiratory events; heavily
concentrated in patients with significant underlying
multi-organ comorbidities and discussed candidly
beforehand.
Where ERCP cannot be completed — uncommon, and typically due to anatomical variation — alternative options (repeat procedure, single-stage laparoscopic bile duct exploration, or surgical rendezvous) are discussed directly by the same consultant.
COMPARATIVE PATHWAYS
Diagnostic & interventional alternatives
Choosing the least invasive, highest-yield pathway suited precisely to your anatomical findings.
MRCP
NON-INVASIVE
Magnetic Resonance Cholangiopancreatography
An advanced magnetic resonance scan dedicated to the biliary architecture. Provides exquisite diagnostic cross-sectional imagery with zero procedural risk or radiation.
Scope: Diagnostic only
Limitation: Cannot extract stones or place stents
EUS
HIGH RESOLUTION
Endoscopic Ultrasound
Provides superior spatial resolution compared to MRI. Highly valuable when scan results are equivocal or when a stone may have spontaneously passed into the bowel.
Advantage: Can precede ERCP under same
sedation
Benefit: Prevents unnecessary duct cannulation
Surgery
SINGLE-STAGE
Laparoscopic Bile Duct Exploration
Surgical extraction of bile duct calculi at the exact same time as gallbladder removal. Completely eliminates post-ERCP pancreatitis risk under one general anaesthetic.
Key Factor:Evaluated when anatomy favors surgery
Performed by: Mr Johnston personally
CLEAR GUIDANCE
Frequently asked questions
Straightforward, transparent clinical answers to help you prepare for your consultation and
procedure.
Have a specific clinical enquiry?
Contact practice secretary Kamila Piotrowska for guidance on referrals and appointments.
0131 210 0350
Is ERCP painful?
No. Over 90% of ERCPs are performed as a well-tolerated day-case procedure under deep intravenous conscious sedation. Most patients remember very little to nothing of the procedure. Mild bloating or a scratchy throat afterwards is common and short-lived.
How quickly can it be arranged?
The timing of ERCP is strictly prioritised based upon clinical urgency — for example, if you are actively jaundiced or have signs of cholangitis, admission is expedited rapidly. Routine elective therapeutic procedures are typically scheduled within 4 to 6 weeks from your initial consultation.
How much does it cost?
Mr Johnston is fully fee-assured with all major UK medical insurance providers (including Bupa, AXA Health, Aviva, Vitality, Cigna, and WPA), meaning his fees adhere strictly to approved insurer schedules with no unexpected procedural shortfalls. Transparent self-pay packaged pricing is also available on request.
Who will actually do my procedure?
Mr Chris Johnston personally assesses you, conducts the ERCP procedure, and undertakes subsequent gallbladder surgery if required (or liaises directly with your referring specialist). Your care is entirely consultant-delivered from start to finish without delegating to trainees.
Clinical Authorship & Governance: Written and reviewed 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 reviewed:13 August 2026
DIRECT CLINICAL ENQUIRIES
Jaundice, duct stones, or a scan you'd like explained?
Arrange an expert clinical review of your MRCP or CT scans, receive guidance on acute symptoms, or schedule a formal surgical and endoscopic consultation at Spire Murrayfield or Shawfair Park Hospital.
Secretarial hours: Monday – Friday, 9:00am – 5:00pm. Direct GP and private referrals accepted.
APPROVED & FEE-ASSURED WITH ALL MAJOR PROVIDERS:
BUPA
AXA HEALTH
AVIVA
VITALITY
WPA
CIGNA
Research publications: ORCID 0000-0001-9935-7365