Overview
Bile flows from the liver and gallbladder through the common bile duct into the small intestine. When a gallstone gets stuck in the bile duct (choledocholithiasis), bile cannot drain. Pressure builds → jaundice. If bacteria from the intestine ascend, infection develops (cholangitis) — a medical emergency.
Symptoms
Right upper or middle abdominal pain
Yellow eyes and skin (jaundice)
Dark urine, pale stools
Itching
Fever and chills (suggests cholangitis — emergency)
Nausea and vomiting
Self-Care Tips
Get cholecystectomy after ERCP — prevents future stones from gallbladder.
Healthy weight, regular meals, exercise.
When to See a Doctor
Seek medical care promptly if you notice: Charcot's triad: fever + jaundice + right upper abdominal pain; Reynold's pentad: above + confusion + low blood pressure; Severe pain spreading to the back.
Why it happens
Stones from the gallbladder pass into the bile duct, get stuck, and obstruct bile flow. Less commonly, stones form within the bile duct itself (primary).
How common it is
About 10-15% of patients with gallstones will develop bile duct stones. Cholangitis develops in a smaller fraction but requires urgent treatment.
ERCP is performed at all Saudi tertiary and most secondary hospitals. Same-day ERCP for cholangitis is standard of care.
How it is diagnosed
Blood tests: elevated bilirubin, ALP, GGT (cholestatic pattern); WBC if infection. **MRCP** is the best non-invasive test to see bile duct stones. **EUS** can find smaller stones. **ERCP** is both diagnostic and therapeutic — removes the stones.
Lifestyle and daily habits
Once you've had bile duct stones, prevent recurrence.
• Get cholecystectomy after ERCP — prevents future stones from gallbladder.
• Healthy weight, regular meals, exercise.
Diet
No specific diet for cholangitis — treat as for gallstones.
• Mediterranean diet.
Medicines
Antibiotics for cholangitis.
• IV antibiotics (piperacillin-tazobactam or ciprofloxacin + metronidazole) for cholangitis.
• Ursodeoxycholic acid post-ERCP can reduce stone recurrence in patients keeping their gallbladder.
Procedures and surgery
ERCP is the definitive treatment.
• ERCP — endoscopic removal of stones; same-day or overnight stay.
• Cholecystectomy after ERCP — prevents future bile duct stones from gallbladder.
• Percutaneous biliary drain — if ERCP fails or anatomy prevents.
Outlook
Excellent if treated promptly. ERCP successfully removes 90%+ of stones. Cholangitis treated within 24 hours has excellent outcomes; delayed treatment significantly worse. Cholecystectomy usually follows ERCP to prevent recurrence.
Questions to ask your doctor
• Should I have my gallbladder removed after the ERCP?
• When is the right time to do the cholecystectomy?
• What if there are more stones in the bile duct?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Patient Education Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is Bile Duct Stones & Cholangitis?
How is Bile Duct Stones & Cholangitis diagnosed?
What is the outlook for Bile Duct Stones & Cholangitis?
When should I see a doctor about Bile Duct Stones & Cholangitis?
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