ERCP for Bile Duct Stones

Common symptoms include upper abdominal pain, nausea, jaundice, dark urine or pale stools. Some patients may also experience fever and chills if infection develops. When left untreated, bile duct stones can lead to serious complications such as cholangitis (infection of the bile duct), biliary obstruction or pancreatitis, all of which require urgent medical care.

What is ERCP?

ERCP, short for Endoscopic Retrograde Cholangiopancreatography, is a procedure that allows doctors to both identify and treat blockages in the bile or pancreatic ducts during the same session. It’s most often used when bile duct stones are suspected to be causing jaundice, infection, or abdominal pain.

Unlike imaging scans such as ultrasound or MRCP, ERCP not only shows the obstruction but also enables immediate treatment, such as removing stones or inserting a stent to restore normal bile flow.

How does ERCP work?

ERCP is performed under sedation or light anaesthesia to ensure comfort. The procedure typically takes 30 to 60 minutes and is carried out using a flexible endoscope and X-ray guidance to access and clear the bile ducts safely.

• Preparation — patients are asked to fast for several hours before the procedure. The doctor reviews current medications and medical history, especially blood thinners, diabetes medications or allergies.
• Insertion of the endoscope — a thin, flexible tube with a camera (endoscope) is gently passed through the mouth, down the oesophagus and stomach and into the duodenum, where the bile duct opens.
• Injection of contrast dye — a fine catheter is guided through the endoscope, and a contrast dye is injected into the bile ducts. This dye highlights any stones, narrowing or blockages on X-ray images.
• Stone removal or stent placement —once the blockage is located, the duct opening may be widened (sphincterotomy). Special tools such as small baskets or balloons are used to remove the stones. In some cases, a temporary stent is inserted to maintain bile drainage.
• Completion and recovery — after the procedure, patients are monitored while the sedation wears off. Most can eat once fully awake and return home the same day or after an overnight stay if needed.

This method allows both diagnosis and treatment in one procedure, providing effective relief from bile duct obstruction with minimal recovery time.

When is ERCP recommended for bile duct stones?

ERCP is recommended when bile duct stones cause symptoms or complications that require immediate relief of obstruction.

• Common indications — ERCP is most often performed when patients develop jaundice (yellowing of the skin and eyes), cholangitis (infection of the bile duct), pancreatitis or biliary obstruction seen on imaging. These conditions occur when stones block the normal flow of bile, leading to pain, fever or elevated liver enzymes.
• When immediate intervention is needed — urgent ERCP may be required in cases of high fever, persistent right upper abdominal pain or infection with chills and low blood pressure, all signs of acute cholangitis or severe obstruction. Prompt removal of the stones helps restore bile flow and prevent complications such as sepsis or organ inflammation.
• When alternative approaches may be considered — if ERCP is not possible or fails to remove all stones, other options such as percutaneous drainage or surgical exploration may be considered. These are typically reserved for complex cases where anatomy, stone size, or scar tissue make endoscopic access difficult.

In most patients, however, ERCP remains the preferred and safest primary treatment approach for bile duct stones, offering fast symptom relief and a short recovery period.

What are the benefits of ERCP for bile duct stones?

ERCP offers a safe and effective way to treat bile duct stones without the need for open surgery. As a minimally invasive procedure, it provides both diagnosis and treatment in one session, reducing the need for multiple tests or hospital visits.

• Minimally invasive alternative to surgery — ERCP accesses the bile ducts internally through the digestive tract, avoiding external cuts or incisions. This approach reduces pain, bleeding risk and recovery time compared to traditional surgery.
• Short recovery time and symptom relief — most patients experience immediate improvement in symptoms such as jaundice, abdominal pain or nausea once the stones are removed. Recovery is typically quick, with most returning home the same day or after a short stay.
• High success rates in stone clearance — in experienced hands, ERCP achieves stone clearance in more than 90% of suitable cases. It also allows the placement of stents or drainage tubes when needed, ensuring long-term relief and preventing recurrence.

What are the risks or complications of ERCP?

While ERCP is generally safe, it is a specialised procedure that carries certain risks, particularly in patients with inflamed or narrowed bile ducts.

• Possible side effects — mild, short-term effects such as a sore throat, bloating or abdominal discomfort can occur after the procedure and usually resolve within a day or two.
• Rare but serious complications — in uncommon cases, ERCP can cause pancreatitis (inflammation of the pancreas), bleeding or infection of the bile ducts. These are managed promptly with medication or short hospital observation.

How risks are minimised

At Alpine Surgical Practice, ERCP is performed by trained specialists using detailed imaging and precision instruments. Careful patient selection, gentle technique and close monitoring before and after the procedure help ensure safety and the best possible outcomes.

How to prepare for an ERCP procedure? 

Proper preparation helps ensure the procedure is safe and smooth. Your doctor will provide specific instructions before your appointment, which usually include fasting, reviewing medications, and arranging for post-procedure care.

• Fasting — patients are advised not to eat or drink for at least six hours before ERCP to keep the stomach empty. This reduces the risk of aspiration during sedation.
• Medication review — inform your doctor of all medicines you are taking, especially blood thinners, diabetes medications or supplements. Some may need to be adjusted or temporarily stopped before the procedure.
• Medical history — share details of any allergies, heart or lung conditions or bleeding disorders. This information helps the team tailor sedation and safety measures to your needs.
• Accompaniment — arrange for a family member or friend to accompany you, as you will not be able to drive after sedation.
• Hospital stay and discharge — ERCP is usually done as a day procedure. Most patients go home the same day once the sedative wears off, but an overnight stay may be advised if you had an infection, multiple stones, or stent placement.

What to expect after ERCP?

After ERCP, patients are monitored as the sedation wears off. Mild bloating or a sore throat is common and usually short-lived. Most people recover quickly and can return home the same day or after an overnight stay if needed.

• Recovery and monitoring — you will rest in a recovery area where your pulse, blood pressure and breathing are observed. Once fully awake, you can start drinking fluids and gradually return to normal meals as advised by your doctor.
• Resuming activities — most patients can walk and move about soon after the procedure but are advised to rest for the remainder of the day. Normal daily activities can usually be resumed within 24 hours unless otherwise instructed.
• Follow-up and aftercare — a review appointment or ultrasound may be scheduled to confirm that the bile ducts are clear and functioning well. Your doctor will also discuss any long-term measures to prevent recurrence of bile duct stones.

When should you seek medical help after ERCP? 

Most patients recover smoothly after ERCP, but certain symptoms may indicate a complication and require prompt medical attention. It’s important to monitor your condition closely in the first few days following the procedure.

Warning signs to watch for after an ERCP 

Contact your doctor immediately if you experience:

• Persistent or severe abdominal pain
• Fever, chills, or shivering
• Jaundice (yellowing of the skin or eyes)
• Nausea or vomiting that does not settle

Why prompt review is important 

These symptoms may suggest pancreatitis, infection or bleeding after the procedure. Early evaluation allows timely treatment and prevents serious complications.

At Alpine Surgical Practice, patients are given clear aftercare instructions and emergency contact details to ensure safe recovery and peace of mind after ERCP.

Summary 

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a minimally invasive procedure used to diagnose and treat bile duct stones that obstruct the normal flow of bile. It offers both diagnostic clarity and therapeutic relief in a single session, helping to remove stones, restore bile drainage and prevent serious complications such as jaundice, cholangitis or pancreatitis. With careful preparation, skilled execution, and close post-procedure monitoring, most patients recover quickly and resume normal activities within a short time.

If you are experiencing symptoms such as jaundice, abdominal pain or unexplained digestive discomfort, schedule a consultation with Dr Aaron Poh to discuss whether ERCP is the right treatment for your bile duct stones and receive expert, personalised care.