How ERCP Cleared a Bile Duct Stone Without Surgery
Patient Profile
| Age | 55 years |
| Gender | Male |
| Occupation | Wholesale Trader (self-employed) |
| City | Pune |
| Presenting Complaint | Severe right-upper-abdominal pain radiating to the back, yellowing of the eyes and skin, dark urine, and intermittent fever with chills |
| Diagnosis | Choledocholithiasis (common bile duct stone) with obstructive jaundice and early cholangitis |
| Duration of Issue | Acute flare over 6 days; recurrent gallstone-type pain for roughly 8 months |
| Previous Treatments | Painkillers and antacids from a local clinic, with no imaging and no definitive diagnosis |
| Date of Procedure | November 2024 (ERCP); managed over a single short admission |
| Outcome | Stone fully cleared endoscopically, jaundice resolved, bile flow restored, no surgery required |
Patient identity withheld per confidentiality guidelines. Patient name is not included; all other fields are accurate.
The Problem
Condition
A common bile duct stone forms when a gallstone slips out of the gallbladder and lodges in the narrow tube that carries bile from the liver into the intestine. When that tube is blocked, bile backs up into the bloodstream and the patient turns yellow, a state called obstructive jaundice. This patient had a single obstructing stone confirmed on ultrasound and MRCP, with a dilated bile duct upstream and liver tests pointing clearly to a blockage rather than to a primary liver disease. Prompt assessment through Endoscopic Services in Pune allowed the stone to be located accurately before any procedure. Trapped bile is not just uncomfortable. It allows infection to build inside the duct, a dangerous condition known as cholangitis, and the patient had already begun running fevers with chills by the time he was seen.
Emotional & Psychological Impact
For a self-employed trader who runs his own shop floor every day, turning visibly yellow was frightening and impossible to ignore. He had pushed through eight months of on-and-off pain, blaming it on spicy food and acidity, and had quietly worried that the yellow colour meant something had gone seriously wrong with his liver. The fever and the back pain frightened his family, and he had heard that gallstone problems always end in open surgery and a long recovery he could not afford to take. By the time he reached structured care he was anxious, exhausted from disturbed sleep, and convinced he was facing a major operation, a fear that a clear, stepwise endoscopic plan would soon settle.
Consultation & Treatment Plan
What Was Assessed During the Consultation?
- Detailed history of recurrent biliary pain, fatty-food intolerance, and the recent onset of jaundice, dark urine, and pale stools
- Clinical examination confirming scleral icterus, right-upper-quadrant tenderness, and low-grade fever suggesting early cholangitis
- Liver function tests showing a sharply raised bilirubin, ALP, and GGT in an obstructive pattern, with mildly elevated ALT and AST
- Abdominal ultrasound and MRCP to confirm the stone, measure the dilated common bile duct, and map the anatomy before any procedure
- Patient goals, clear the blockage quickly, settle the infection, avoid open surgery, and return to work with minimal downtime
Why This ERCP-Based Approach Was Chosen
Dr. Ksheetij Kothari selected ERCP Test (endoscopic retrograde cholangiopancreatography) as a same-sitting diagnostic and therapeutic procedure rather than moving straight to open surgery. The reasoning:
- ERCP over open surgery: the stone could be reached and removed through the mouth via an endoscope, clearing the duct without any abdominal incision and with a far shorter recovery.
- Treating the infection at source: relieving the blockage allows infected bile to drain, which is the single most effective step in controlling cholangitis alongside antibiotics.
- Restoring bile flow first: with the duct cleared and a sphincterotomy performed, bile drains freely and the jaundice reverses, stabilising the patient before any later gallbladder surgery.
- Staged, sensible sequencing: clearing the duct endoscopically first, then planning elective gallbladder removal later, spares the patient an emergency open operation while still preventing future attacks.
Baseline Imaging & Documentation
Baseline imaging documents the starting clinical condition and anchors the ERCP plan. Ultrasound, MRCP, and liver function tests were performed before the procedure to confirm the stone, the degree of duct dilation, and the severity of the obstruction.
Management Protocol:- Step by Step
- Baseline bloods and imaging recorded to fix an objective starting point (bilirubin, ALP, GGT, ALT, AST, white cell count, and MRCP findings)
- Resuscitation and intravenous antibiotics started immediately to control the early cholangitis before the procedure
- Therapeutic ERCP performed under sedation, with the bile duct cannulated and a cholangiogram confirming the obstructing stone
- Endoscopic sphincterotomy carried out to widen the duct opening, followed by balloon and basket extraction of the stone
- Completion cholangiogram to confirm the duct was fully cleared and bile was draining freely into the intestine
- Short post-procedure observation for pancreatitis or bleeding, with repeat liver tests to confirm the obstruction was resolving
- Discharge with a plan for elective laparoscopic gallbladder removal to prevent any future stones
Management Facts
| Procedure Duration | Single short hospital admission with one therapeutic ERCP session |
| Anaesthesia | Sedation only, no open surgery and no general anaesthetic incision |
| Key Therapeutic Tool | ERCP with sphincterotomy and balloon/basket stone extraction |
| Approach | Endoscopic duct clearance plus antibiotics, then planned elective gallbladder surgery |
| Complications | None |
| Hospital Stay | Short, with discharge once bile flow and liver tests improved |
Post-Management Results
Within days of the ERCP the patient’s pain settled, his fever resolved, and the yellow tinge in his eyes and skin began to fade. Repeat liver tests showed bilirubin and the obstructive enzymes falling steadily back toward normal, confirming that bile was draining freely again. The duct was confirmed clear on the completion cholangiogram, the early cholangitis was controlled, and he was able to return home and back to work quickly, with elective gallbladder surgery planned to prevent recurrence.
Outcomes at a Glance
| Outcome Metric | Result |
| Bile Duct Stone | ✔ Cleared, duct fully clear on completion cholangiogram |
| Obstructive Jaundice | ✔ Resolved, bilirubin normalised |
| Liver Enzymes (ALP/GGT) | ✔ Markedly improved toward normal |
| Cholangitis (Infection) | ✔ Controlled, fever and chills settled |
| Patient Satisfaction | ✔ Very high, fast relief and no open surgery |
| Complications | ✔ None |
Patient Feedback
“I was terrified when I turned yellow, I thought I needed a big operation and weeks off work. Instead the stone was removed through a scope, the pain and fever went within days, and the colour came back to normal. The team explained each step clearly and I was back at my shop far sooner than I expected.”
Profile: Male · 55 years · Wholesale Trader · Pune
Procedure: ERCP for common bile duct stone · Pune · November 2024
Surgeon: Dr. Ksheetij Kothari · Consultant Gastroenterologist
Ongoing Care & Maintenance
Instructions Given to Patient
- Proceed with the planned elective laparoscopic gallbladder removal to prevent further stones forming and migrating
- Adopt a lower-fat, balanced diet and stay well hydrated to reduce the risk of new stone formation
- Watch for and report any return of pain, fever, yellowing, or dark urine without delay
- Complete the full course of prescribed antibiotics and attend the scheduled review with repeat liver tests
- Avoid self-medicating with painkillers or antacids in place of proper assessment if symptoms return
- Attend follow-up to confirm liver tests have fully normalised after the duct clearance
Recovery & Reversal Timeline
| Timeframe | What the Patient Could Expect |
| First 24–48 hours | Pain settling, fever controlled with antibiotics, early relief after duct clearance |
| Days 3–5 | Jaundice visibly fading; bilirubin and obstructive enzymes trending down; discharge home |
| Weeks 1–2 | Return to normal activity and work; repeat liver tests confirming improvement |
| Following weeks | Elective laparoscopic gallbladder removal to prevent recurrence |
| Ongoing | Periodic review to confirm liver tests stay normal and no new stones form |
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