Concierge gastroenterology · London
Endoscopic retrograde cholangiopancreatography, done therapeutically, in the right hands.
A therapeutic ERCP is a specialist procedure — bile-duct stones, strictures, leaks and drainage of infection. We book you into a JAG-accredited unit with a high-volume biliary endoscopist, MRCP first, and post-ERCP pancreatitis prophylaxis as standard.
Why patients choose us
- 01
A JAG-accredited unit, a high-volume endoscopist
ERCP is not an all-rounder’s procedure. We book you into a JAG-accredited unit with a therapeutic biliary endoscopist who does hundreds of cases a year.
- 02
MRCP first, ERCP only when it will treat
ERCP is no longer a diagnostic test — MRCP or EUS answers the question first. We arrange the imaging, then book the therapeutic ERCP only when there is something to fix.
- 03
Independent, and free
We are paid by no unit, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private ERCP costs in London.
Indicative ranges across our JAG-accredited network. Send your details and we quote firm figures across two or three options.
In short
A therapeutic ERCP with stone extraction in our network: £3,500–£6,500, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Diagnostic MRCP (done first) | £650–£1,100 | 30 min | Report in 24–48 hrs |
| ERCP with sphincterotomy and stone extraction | £3,500–£6,500 | 45–75 min | Same day home |
| ERCP with plastic biliary stent | £3,800–£6,800 | 45–75 min | Same day home |
| ERCP with self-expanding metal stent (SEMS) | £5,500–£9,500 | 60–90 min | Same day home |
| ERCP with cholangioscopy (SpyGlass) and lithotripsy | £7,500–£12,000 | 90 min | Overnight stay possible |
| EUS-guided rendezvous or altered-anatomy ERCP | £8,000–£14,000 | 90–120 min | Overnight stay likely |
| Consultation only | £250–£450 | 30 min | Same visit |
Prices vary by unit, by which endoscopist does the case, by anaesthetic model (sedation vs anaesthetist-delivered propofol), and by whether SEMS, cholangioscopy or altered-anatomy access are needed. We come back with a firm quote within one working day.
The problem
The right imaging first, then a therapeutic ERCP — done once, done well.
ERCP is one of the highest-risk endoscopy procedures. Volume matters, pancreatitis prophylaxis matters, and doing the diagnostic imaging first matters most of all.
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MRCP or EUS first, always
ERCP no longer has a diagnostic role. We arrange MRCP or EUS to answer the question, then book ERCP only when there is a job to do.
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PEP prophylaxis as standard
Rectal indomethacin or diclofenac 100 mg is given at the procedure, and a prophylactic pancreatic stent is placed in higher-risk cases.
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High-volume endoscopist
A named biliary endoscopist with a therapeutic ERCP volume that meets BSG standards — not a generalist doing the occasional case.
The journey
From enquiry to recovery — what happens, in order.
One point of contact from first message through recovery, stent exchange and follow-up.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the unit
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Jaundice, pain, LFTs, any prior imaging, and whether you have altered anatomy from previous surgery.
- 02
Before
We come back with a recommendation
Within one working day: MRCP or EUS first if diagnosis is not yet clear, then a therapeutic ERCP list with a named biliary endoscopist and an indicative price.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Blood thinners are reviewed, antibiotics arranged if cholangitis is suspected, and you are told exactly how to fast.
- 04
On the day
Arrival at the unit
Arrival, consent, a chat with the endoscopist and anaesthetist. Sedation with midazolam and fentanyl for straightforward cases; propofol with an anaesthetist for complex, long or altered-anatomy work.
- 05
On the day
The procedure itself
30 to 90 minutes in a fluoroscopy-equipped endoscopy room. Duodenoscope to the ampulla, cannulation, cholangiogram, then the therapeutic step — sphincterotomy, stone extraction, stricture dilation or a stent.
- 06
On the day
Recovery and home the same day
A few hours of observation for pain, bleeding and early pancreatitis. Most patients go home the same day; complex cases stay one night.
- 07
After
Follow-up and any repeat ERCP
LFTs are checked, imaging reviewed, and any plastic stents planned for exchange at three months. A named point of contact for the first 48 hours.
Typical end-to-end: 1–2 weeks from enquiry to ERCP. Plastic stents exchanged at ~3 months.
When it helps
When a therapeutic ERCP is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Choledocholithiasis (bile-duct stones)
Stones in the common bile duct causing jaundice, pain or abnormal LFTs — sphincterotomy plus balloon or basket extraction is the standard therapeutic step.
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Biliary stricture — benign or malignant
Narrowing from stones, inflammation, PSC or tumour. Brushings and biopsies for tissue, then a plastic or self-expanding metal stent for drainage.
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Pancreatic-duct stricture or leak
Chronic pancreatitis strictures, disconnected duct syndrome or post-operative pancreatic leaks — pancreatic stenting and sphincterotomy where indicated.
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Bile leak after cholecystectomy or trauma
A cystic-duct stump or duct-of-Luschka leak after gallbladder surgery — a temporary biliary stent lowers ductal pressure and lets the leak seal.
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Ascending cholangitis needing urgent drainage
Fever, jaundice and right-upper-quadrant pain (Charcot’s triad) — antibiotics plus urgent ERCP for biliary decompression within 24–48 hours.
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Ampullary adenoma or early carcinoma
Endoscopic ampullectomy (papillectomy) for selected ampullary neoplasia, with pancreatic and biliary stenting to protect the ducts afterwards.
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Altered anatomy — Roux-en-Y or gastric bypass
Access via double-balloon enteroscopy-assisted ERCP or EUS-directed transgastric ERCP (EDGE). A niche skill — done only in specialist units.
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Red flag: fever and jaundice — same day
Fever, jaundice and abdominal pain together suggest cholangitis. This is not a clinic booking — go to A&E for antibiotics and urgent drainage.
Procedure options
ERCP is not one procedure — it is a toolkit.
What each option actually involves — and which fits which problem.
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MRCP first (diagnostic imaging)
Non-invasive MR imaging of the biliary and pancreatic ducts. The right first test — ERCP no longer has a diagnostic role on its own.
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EUS with fine-needle biopsy
Endoscopic ultrasound for small stones, indeterminate strictures and pancreatic masses — often paired with ERCP on the same list.
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ERCP with sphincterotomy and stone extraction
The workhorse: cut the sphincter of Oddi, sweep the duct with a balloon or basket, and clear stones up to about 15 mm.
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Mechanical, EHL or laser lithotripsy
For large or impacted stones that will not come out whole — crushed with a mechanical basket, or fragmented under cholangioscopy with electrohydraulic or holmium laser lithotripsy.
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Cholangioscopy (SpyGlass)
A thin scope passed through the duodenoscope into the bile duct itself — for direct-vision biopsies of strictures and targeted lithotripsy of difficult stones.
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Plastic vs metal biliary stents
Plastic stents for benign strictures and short-term drainage (exchanged at three months). Self-expanding metal stents — fully, partially or uncovered — for malignant obstruction and selected benign disease.
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Ampullectomy (papillectomy)
Endoscopic removal of ampullary adenomas or early carcinomas, with prophylactic pancreatic stenting to reduce post-procedure pancreatitis.
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Altered anatomy — DBE-ERCP or EDGE
Roux-en-Y and gastric-bypass patients reached via double-balloon enteroscopy, or via an EUS-created gastro-gastric fistula (EUS-directed transgastric ERCP).
Our vetted London network
A small panel of biliary endoscopists, we picked them.
JAG-accredited units across central London with high therapeutic ERCP volumes. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every endoscopist and unit in our network.
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JAG-accredited endoscopy units meeting BSG ERCP standards
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Consultant biliary endoscopists with high therapeutic ERCP volume
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Anaesthetist-delivered propofol available for complex and altered-anatomy cases
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On-site interventional radiology and HPB surgery for backup
Safety and recovery
The real risks of ERCP — honestly.
ERCP is one of the highest-risk endoscopy procedures. Volume, prophylaxis and the right unit are what change your odds — not marketing.
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Post-ERCP pancreatitis (PEP) — 3 to 10%
The commonest specific complication. Risk is higher in young women, normal-calibre bile ducts and suspected sphincter of Oddi dysfunction. Rectal indomethacin or diclofenac 100 mg and a prophylactic pancreatic stent both reduce it.
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Bleeding after sphincterotomy — 1 to 2%
Usually self-limiting; managed at the same session with adrenaline injection, clips or thermal therapy. Blood thinners are reviewed carefully beforehand.
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Perforation — 0.5 to 1%
Rare but serious — retroperitoneal from the sphincterotomy, or from the duodenoscope itself. Managed with clips, stenting, drainage or surgery depending on type.
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Cholangitis if drainage is incomplete
A partially drained obstructed system can seed infection. Antibiotics are given at induction and drainage is planned to be complete in one session where possible.
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Sedation and anaesthetic risks
Propofol is delivered by an anaesthetist for complex cases; midazolam and fentanyl for straightforward work. Both carry the usual small cardiorespiratory risks.
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Contrast and radiation
A small dose of iodinated contrast is injected under fluoroscopy. Allergy history is checked and radiation dose is kept as low as reasonably achievable.
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Duodenoscope infection background
Duodenoscopes have a complex elevator mechanism. UK units follow enhanced reprocessing and surveillance protocols to minimise the very small residual infection risk.
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Stent occlusion and migration
Plastic stents typically need exchange at three months. Metal stents last longer but can occlude with tumour ingrowth or tissue reaction — planned surveillance matters.
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Red flags after ERCP
Severe abdominal pain, fever, vomiting, black stools or a rising heart rate in the first 24 to 48 hours are not normal — call the unit or attend A&E the same day.
Reading your ERCP report
Your ERCP report in four parts. Read the last one first.
Whatever the therapeutic step, the note the endoscopist sends you keeps to the same shape.
A quiet reminder
Endoscopy language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 Header
Indication and imaging summary
Why the ERCP was done — stones, stricture, leak, cholangitis — with a summary of the MRCP or EUS that led to it.
- 02 Technique
Cannulation, sphincterotomy and devices
How the ampulla was cannulated, whether a sphincterotomy was performed, and which devices (balloons, baskets, SpyGlass, lithotripter) were used.
- 03 Findings
Cholangiogram findings and therapeutic step
What the cholangiogram showed — stones, stricture length, leak site — and what was done: extraction, dilation, stenting, brushings or biopsies.
- 04 Impression
Recovery, PEP prophylaxis and next steps
Read this first: pancreatitis prophylaxis given (rectal NSAID, pancreatic stent), planned stent exchange, follow-up imaging and any repeat ERCP timing.
Recognised by major UK insurers
Cover for ERCP is usually straightforward when medically indicated — stones, strictures, cholangitis, leaks. Cholangioscopy and altered-anatomy access sometimes need pre-authorisation. We confirm cover before booking.
Frequently asked
Everything we get asked about ERCP.
Quick answers on pancreatitis risk, plastic vs metal stents, altered anatomy, and what recovery actually looks like.
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Is ERCP still used to diagnose bile-duct problems?
No — not on its own. MRCP or EUS is the right first test because ERCP carries a real risk of pancreatitis. ERCP is now reserved for therapeutic work: clearing stones, dilating strictures, placing stents, or draining infection.
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How likely is post-ERCP pancreatitis, and how is it prevented?
Overall risk is 3–10%, higher in young women with a normal-calibre bile duct or suspected sphincter of Oddi dysfunction. Rectal indomethacin or diclofenac 100 mg at the procedure and, for high-risk cases, a small prophylactic pancreatic stent both meaningfully reduce it. Both are standard in our network.
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How much does a private ERCP cost in London?
Roughly £3,500–£6,500 for a straightforward stone extraction, £3,800–£6,800 with a plastic biliary stent, and £5,500–£9,500 with a self-expanding metal stent. Cholangioscopy with lithotripsy or EUS-directed access for altered anatomy runs higher. We confirm a firm figure within one working day.
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Sedation or general anaesthetic?
Straightforward cases are done under midazolam and fentanyl sedation. Long, complex, cholangioscopy or altered-anatomy cases are done with anaesthetist-delivered propofol sedation or a full general anaesthetic. The endoscopist and anaesthetist agree the plan with you before the list.
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What is the difference between plastic and metal biliary stents?
Plastic stents are cheap, easy to place and easy to exchange — used for benign strictures and short-term drainage, typically swapped at three months to prevent clogging. Self-expanding metal stents (SEMS) are wider and last longer — used mostly for malignant obstruction, and come as fully covered, partially covered or uncovered depending on the indication.
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Can ERCP be done if I have had a gastric bypass or Roux-en-Y?
Yes, but only in specialist units. Options are double-balloon enteroscopy-assisted ERCP (a long scope through the bypassed limb) or EUS-directed transgastric ERCP (EDGE), where an EUS-guided lumen-apposing metal stent creates a temporary gastro-gastric access. We book these cases only where the team does them regularly.
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What does recovery look like, and when can I eat?
You will be watched for a few hours for pain, bleeding and early pancreatitis. Most patients start clear fluids after two hours and a light meal the same evening, going home the same day. Complex cases and cholangitis usually stay one night.
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When should I ring the unit or go to A&E after an ERCP?
Severe or worsening abdominal pain, a temperature over 38 °C, repeated vomiting, black or tarry stools, or bright bleeding in the first 24 to 48 hours all need same-day contact. These can point to pancreatitis, bleeding, cholangitis or perforation and none should be left until morning.
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