ERCP (endoscopic retrograde cholangiopancreatography) uses a flexible camera passed through the mouth to reach the bile duct, so stones can be removed and blockages relieved without cutting the skin. Dr Kan Yuk Man performs ERCP as well as keyhole gallbladder surgery.
ERCP combines an endoscopy with X-rays. A thin, flexible endoscope is passed through the mouth and stomach into the duodenum, the first part of the small intestine, where the bile duct opens (the papilla).
The doctor passes a fine tube into the bile duct and injects contrast dye that shows up on X-ray. Stones can then be removed with a small balloon or basket, the opening can be widened with a small cut inside the gut (sphincterotomy), and a stent can be placed to keep a blocked duct open.
Because it carries some risks, ERCP is now mainly used to treat problems. Bile duct stones are usually diagnosed first with ultrasound and MRCP (an MRI scan of the bile ducts).
Gallstones that have moved into the bile duct are cleared, by ERCP or during keyhole surgery, and the gallbladder is removed.
A blocked, infected bile duct (cholangitis) or jaundice from a stone needs prompt drainage, often by urgent ERCP.
Gallstone pancreatitis with a blocked bile duct, and narrowings that need a stent to keep bile flowing.
If the bile duct cannot be fully cleared, a stent can drain bile as a temporary measure until the stones are removed. See all gallstone treatment options.
You will be asked not to eat or drink for some hours beforehand. Tell your doctor about blood thinners and allergies, especially to contrast dye.
Under sedation or general anaesthesia, the endoscope is passed through the mouth. It often takes under an hour, longer for complex stones.
Everything is done through the endoscope, so there are no wounds on the abdomen.
You are watched for a few hours as the sedation wears off. A sore throat for a day or so is common. You will be told when you can start eating and drinking again.
Some people go home the same day; others stay overnight, especially after an urgent procedure. If you still have your gallbladder, Dr Kan will discuss when to remove it by keyhole surgery to prevent new stones.
Go to the emergency department or call 995.
ERCP is generally safe, but it carries more risk than a routine endoscopy. Figures vary between studies and with each person’s situation:
Inflammation of the pancreas is the most common complication, reported in roughly 3 to 10 in every 100 procedures. Most cases are mild.
Bleeding, mostly after the opening is widened, affects up to about 2 in 100. Infection of the bile duct affects about 1 to 3 in 100.
A tear in the bowel or bile duct is rare, under 1 in 100. Sedation and anaesthesia also carry small risks.
The Ministry of Health fee benchmarks for ERCP in private hospitals, including GST:
| Procedure | Surgeon’s / endoscopist’s fee | Anaesthetist’s fee |
|---|---|---|
| ERCP with sphincterotomy and stone removal (SF710B) | S$3,924 – S$5,341 | S$1,417 – S$2,289 |
| ERCP with stent insertion (SF709B) | S$3,706 – S$5,668 | — |
| Diagnostic ERCP (SF711B) | S$3,052 – S$4,251 | S$1,090 – S$1,744 |
Hospital charges are separate. MediSave and Integrated Shield Plans can be used where applicable, and Dr Kan is on several Shield plan specialist panels.
Source: MOH fee benchmarks for surgical procedures.
Common questions about ERCP.
No. ERCP is an endoscopic procedure: the endoscope is passed through the mouth, so there are no cuts on the skin. Any small cut made to widen the bile duct opening is made inside the gut.
ERCP is done under sedation or general anaesthesia, so most people remember little or nothing of it. Your doctor will explain which is planned for you.
It often takes under an hour, and longer for complex cases such as large or multiple stones.
If your bile duct stones came from gallstones and you still have your gallbladder, removing it by keyhole surgery is usually recommended, at the time of ERCP or soon after, to stop new stones causing problems. Dr Kan performs both ERCP and gallbladder surgery, so the two can be planned together.
You are watched for a few hours afterwards. Some people go home the same day; others stay overnight, especially after an urgent procedure or if there are concerns about complications.
Yes, eligible procedures can be partially covered by MediSave and Integrated Shield Plans, subject to policy terms.
Dr Kan Yuk Man performs both ERCP and keyhole gallbladder surgery, so your treatment can be planned by one surgeon.
Disclaimer: This article is for general information only and is not a substitute for medical advice. Please consult a qualified doctor for advice specific to your situation.
Clinical guidance based on NICE guideline CG188 (Gallstone disease), the ESGE guideline on ERCP-related adverse events (2020) and published ERCP complication rates.
