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Health condition · Clinically reviewed

Blocked bile duct, jaundice, MRCP and the ERCP that usually fixes it.

From stones to tumours to strictures: the causes of biliary obstruction, the tests that pin down the level, and the drainage or surgery that restores bile flow.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSG, NICE, EASL and peer-reviewed hepatobiliary sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including MRCP first-line imaging, EUS staging and metal-stent palliation.

Key facts

A blocked bile duct at a glance.

The essentials, in plain English: what it is, how it presents, how it is imaged and how it is fixed in the UK today.

  • What it is

    Biliary obstruction: bile cannot drain from the liver to the duodenum, causing bile to back up and jaundice to develop.

  • Where it blocks

    Intraluminal (stones, sludge), mural (tumour, PSC, strictures) or extraluminal compression (pancreatic head cancer, nodes).

  • Classic sign

    Obstructive jaundice: yellow skin and eyes, dark urine, pale stools and often intense itch (pruritus).

  • Emergency to spot

    Acute cholangitis: fever with jaundice and right upper quadrant pain needs urgent biliary drainage.

  • First-line test

    Ultrasound to confirm duct dilation, then MRCP to map the level and cause of the block without an invasive procedure.

  • How it is fixed

    ERCP with stones removed or a stent placed, PTC if ERCP fails, and surgery for resectable tumours or benign strictures.

Why this guide matters

Cause, level, and a plan to drain.

Biliary obstruction is one of the clearest examples of a problem that is often reversible once the level and the cause are identified. Three ideas anchor the rest of this guide.

  • Level and cause matter

    Intraluminal (stones), mural (tumours, strictures, PSC) and extraluminal (pancreatic head cancer, nodes, Mirizzi) each demand a different plan.

  • MRCP is the map

    Ultrasound confirms dilation and MRCP maps the block without contrast, needles or endoscopy. It steers everything that follows.

  • Cholangitis is time-critical

    Fever plus jaundice plus right upper quadrant pain is an emergency. Drainage within 24 to 48 hours saves lives.

How the diagnosis is made

From first yellow tinge to a clear plan.

The steps a UK gastroenterologist or hepatobiliary team will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and jaundice pattern

    Painless progressive jaundice hints at malignancy; painful intermittent jaundice with fevers suggests stones and cholangitis.

  2. 02

    Assessing

    Bloods and LFTs

    An obstructive picture: raised conjugated bilirubin, ALP and GGT with a modest transaminase rise. Coagulation and vitamin K checked.

  3. 03

    Assessing

    Tumour markers where relevant

    CA 19-9, CEA and AFP if malignancy is suspected. Values are supportive, not diagnostic, and can rise in cholangitis too.

  4. 04

    Confirming

    Ultrasound first, then MRCP

    Ultrasound confirms ductal dilation (CBD wider than 6 to 8 mm). MRCP is the non-invasive gold standard for mapping the block.

  5. 05

    Confirming

    CT and EUS for staging

    CT chest, abdomen and pelvis stages tumours. EUS with FNA or biopsy characterises pancreatic head and distal duct lesions.

  6. 06

    Preparing

    ERCP, PTC or SpyGlass

    ERCP treats stones and places stents. PTC (percutaneous transhepatic cholangiography) is used when ERCP fails. SpyGlass looks inside the duct.

  7. 07

    Preparing

    Cholangitis workup

    Blood cultures, sepsis screen and rapid IV antibiotics if fever, tachycardia or confusion accompany the jaundice.

Typical timeline: bloods and ultrasound on day one, MRCP within days, ERCP or surgery in the same admission when needed.

Symptoms

What a blocked bile duct actually feels like.

The classic mix of jaundice, dark urine, pale stools and itch, plus the emergency features (Charcot triad, Reynolds pentad) that need same-day care.

  • Jaundice

    Yellow skin and sclerae from conjugated bilirubin backing up into the bloodstream.

  • Dark urine, pale stools

    Water-soluble bilirubin colours urine; stools go pale and sometimes greasy from fat malabsorption.

  • Pruritus

    Deep, relentless itch worse at night, often the most distressing symptom of a chronic block.

  • Right upper quadrant pain

    Colicky pain with stones; a duller ache with tumours. Sudden severe pain can flag stone impaction or cholangitis.

  • Charcot triad

    Fever, jaundice and right upper quadrant pain: the hallmark of acute cholangitis and a medical emergency.

  • Reynolds pentad

    Charcot triad plus low blood pressure and confusion: septic cholangitis needing urgent drainage.

  • Weight loss and anorexia

    Unintentional weight loss with painless jaundice raises concern for pancreatic head or bile duct cancer.

  • Courvoisier sign

    A palpable, non-tender gallbladder with jaundice points to malignant obstruction rather than stones.

Treatment

How a blocked bile duct is treated in the UK.

Urgent decompression first, then treat the cause: ERCP for stones, stenting for tumours, surgery for resectable disease and choledochal cysts, plus symptom and nutrition support.

  • ERCP for stones

    Endoscopic sphincterotomy with basket or balloon stone extraction, with mechanical lithotripsy for larger stones. First-line for choledocholithiasis.

  • Biliary stenting

    Plastic stents for short-term drainage before surgery; self-expanding metal stents (SEMS) for palliation of malignant strictures.

  • PTC and internal drainage

    Percutaneous transhepatic cholangiography when ERCP fails or the block is high in the liver. Can leave an internal or external drain.

  • Whipple and hepatectomy

    Pancreaticoduodenectomy for resectable pancreatic head or ampullary cancer. Liver resection for suitable hilar cholangiocarcinoma.

  • Hepaticojejunostomy

    A Roux-en-Y bypass to reconstruct the duct after benign strictures, bile duct injury or choledochal cyst excision.

  • Cholangitis bundle

    Urgent IV antibiotics, fluid resuscitation and biliary drainage within 24 to 48 hours. Sepsis pathway if unwell.

  • Itch and symptom control

    Cholestyramine first-line, then rifampicin, sertraline or naltrexone. MARS (molecular adsorbent recirculating system) for refractory pruritus in specialist centres.

  • Nutrition and vitamins

    Vitamin K to correct coagulopathy, plus fat-soluble vitamin (A, D, E, K) replacement and dietetic input for steatorrhoea.

MDT care

A specialist hepatobiliary MDT is the standard of care.

Complex biliary obstruction is managed at HPB centres by a multidisciplinary team: hepatology, HPB surgery, oncology, interventional radiology, endoscopy and a clinical nurse specialist who coordinates your pathway. Palliation for unresectable disease can include a biliary stent, coeliac plexus block for pain and antipruritic care.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, European hepatology standards and the Tokyo Guidelines for cholangitis, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or hepatobiliary team knows your case and can tell you which parts apply to you. If you develop jaundice with fever or severe pain, seek urgent care.

  • British Society of Gastroenterology (BSG). Guidelines on the management of common bile duct stones.

  • NICE NG188. Cirrhosis in over 16s: assessment and management (biliary and cholestatic sections).

  • EASL Clinical Practice Guidelines. Management of cholestatic liver diseases.

  • Tokyo Guidelines (TG18/TG24). Diagnostic criteria and severity grading for acute cholangitis and cholecystitis.

  • Royal College of Radiologists. iRefer guidance on hepatobiliary imaging and MRCP.

Red flags

When a blocked bile duct needs urgent care.

Most obstruction is dealt with on a planned pathway. These are the situations that are not, and where hospital review is the right call.

  • Acute cholangitis

    Fever, jaundice and right upper quadrant pain: attend A&E. Reynolds pentad (add hypotension and confusion) means septic shock.

  • Painless progressive jaundice

    Especially with weight loss or a palpable gallbladder: urgent two-week-wait referral to rule out pancreatic head or bile duct cancer.

  • Stone with pancreatitis

    Severe epigastric pain radiating to the back with jaundice suggests gallstone pancreatitis: urgent hospital assessment.

  • Bleeding or bruising

    Coagulopathy from vitamin K malabsorption. Any melaena, easy bruising or nosebleeds needs urgent bloods and vitamin K.

  • Confusion or drowsiness

    May reflect septic cholangitis or hepatic decompensation: attend A&E and expect same-day assessment.

  • Post-ERCP fever or pain

    Fever, worsening pain or new jaundice after ERCP can indicate perforation, pancreatitis or infected obstructed system.

  • Post-cholecystectomy jaundice

    New jaundice or ongoing pain after gallbladder surgery may signal a bile duct injury or retained stone.

  • Intractable pruritus

    Itch that stops sleep and does not respond to first-line agents deserves urgent hepatology review.

  • Choledochal cyst in adulthood

    Cyst-related jaundice or pain carries malignant potential: refer to a specialist hepatobiliary centre.

Living with it

While the plan comes together, small things help a lot.

Four practical anchors: eat little and often, treat the itch early, know your stent schedule, and stay inside the hepatobiliary pathway.

A quiet reminder

Bile flow can usually be restored.

Most people improve quickly once the block is drained. Symptoms that persist, or that come back, deserve prompt review rather than watchful waiting.

  1. 01 Diet

    Small, low-fat meals

    While bile flow is impaired, smaller low-fat meals reduce bloating, nausea and steatorrhoea. A dietitian can tailor this if weight is falling.

  2. 02 Skin

    Manage the itch early

    Lukewarm showers, unfragranced emollients and prescribed antipruritics help. Do not scratch to bleeding; ask about escalation if sleep is affected.

  3. 03 Stents

    Know your stent plan

    Plastic stents typically need exchanging every three months. Metal stents last longer but can block. Report any new jaundice or fevers.

  4. 04 MDT

    Stay in the HPB pathway

    Care sits with a hepatobiliary MDT: hepatology, HPB surgery, oncology, interventional radiology and a specialist nurse who coordinates it all.

Frequently asked

Everything we get asked about a blocked bile duct.

Quick answers on causes, imaging, ERCP, stenting and cholangitis.

  • What does a blocked bile duct actually mean?

    It means bile cannot flow from the liver through the bile ducts into the small intestine. Bile backs up, bilirubin rises in the blood and you develop jaundice, dark urine, pale stools and often intense itch. The block can be inside the duct (stones), in the duct wall (tumours or scarring) or pressing on it from outside (pancreatic head cancer or enlarged nodes).

  • What are the most common causes?

    In the UK, bile duct stones (choledocholithiasis) are by far the commonest cause, followed by pancreatic head cancer and cholangiocarcinoma. Less common causes include primary sclerosing cholangitis, IgG4 cholangitis, post-surgical strictures, Mirizzi syndrome, choledochal cysts and, rarely, parasites such as liver fluke.

  • How is it diagnosed?

    Blood tests show an obstructive pattern with a raised bilirubin, ALP and GGT. Ultrasound is the first-line scan to confirm duct dilation and often shows the cause. MRCP is the non-invasive gold standard for mapping the block. CT, EUS and ERCP add staging and tissue diagnosis when a tumour is suspected.

  • Is a blocked bile duct always cancer?

    No. The great majority of cases are due to stones. However, painless progressive jaundice, weight loss and a palpable non-tender gallbladder (Courvoisier sign) raise the suspicion of malignancy and trigger an urgent two-week-wait referral for further imaging and biopsy.

  • How is the block treated?

    Treatment depends on the cause. Stones are usually removed at ERCP with sphincterotomy. Malignant strictures are relieved with a metal stent at ERCP and staged for possible surgery, chemotherapy or radiotherapy. Benign strictures may need balloon dilation, stenting or a hepaticojejunostomy. Choledochal cysts are excised because of malignant potential.

  • What is cholangitis and why does it matter?

    Cholangitis is infection of an obstructed biliary tree. Charcot triad (right upper quadrant pain, jaundice and fever) is classic; Reynolds pentad adds low blood pressure and confusion and signals septic shock. It is a medical emergency needing IV antibiotics, fluids and biliary drainage within 24 to 48 hours.

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