ERCP With Cholangioscopy: What the Extra Camera Adds

After ERCP, seek prompt medical assessment for severe or worsening abdominal pain, fever, black stools, yellow skin or eyes, or vomiting that will not stop. Guy’s and St Thomas’ advises contacting a doctor or going to an emergency department. Tell the clinician you had ERCP; do not wait for follow-up.¹

Standard ERCP: access to the ducts

ERCP uses an endoscope passed through the mouth and X-ray imaging to investigate and treat bile-duct problems. Clinicians can take cell samples with a brush or biopsy and place stents to help blocked bile ducts drain.²

Ask what has already been established in your case and what remains uncertain. If you have had an earlier procedure, request an explanation of its findings before discussing the next one.

You could say: “Which question are you trying to answer, or which problem are you trying to treat, at this appointment?”

Cholangioscopy: a closer view inside the duct

Dudley’s March 2026 leaflet describes cholangioscopy as an additional test during ERCP. An ultrathin endoscope passes through the larger instrument into the bile duct. It allows direct inspection of a narrowing and targeted tissue samples.³

If sampling is proposed, ask which area the clinician wants to examine and how the laboratory result will be discussed. Request an explanation of what the procedure can add to the information already available.

Ask who will put the images, samples and previous findings together for you. Keep that contact with your appointment paperwork.

Difficult stones: a different purpose for the same extra view

The Dudley leaflet also describes using a probe through the cholangioscope to break large bile-duct stones into smaller pieces. The fragments can then be removed using conventional ERCP methods. This treatment is called electrohydraulic lithotripsy.³

If that is your proposed treatment, ask why the specialist recommends it for the stone identified. Have the team explain the alternatives and what happens if the planned treatment cannot be completed.

Discuss the additional procedure before consenting

Cholangioscopy can lengthen ERCP. Its risks include bleeding, pancreatitis and infection of the bile duct. The team should explain the benefits and risks for your circumstances.³

Ask which parts of the procedure are planned and what other steps might be considered during it. Request your own preparation, medicine, transport and recovery instructions; ask the unit to resolve unclear or conflicting directions before making changes.

Before leaving, confirm who explains the findings, whether further appointments are planned and whom to contact about symptoms or missing results.

Bloated by Dinner includes a Test It list and visit script. Use them to organize questions about the purpose of the extra examination and the plan afterward. Explore the digestion playbook.