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Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is one of the highest-risk endoscopic procedures with complications including pancreatitis and even death. ERCP service standards have been introduced, highlighting the importance of collecting feedback from patients. However, little is known about ERCP patient experiences.The Newcastle ENDOPREM was developed to measure upper and lower endoscopy patient reported experiences. To assess and improve ERCP patient experience, we aim to adapt this for ERCP.This study aimed to describe experiences of patients who had undergone ERCP, to later inform adaptation of the Newcastle ENDOPREM.Methods Individuals aged ≥18 years old, who had undergone ERCP between July and October 2024, at a tertiary centre in the North East were eligible to participate. Consenting participants took part in semi-structured telephone interviews. Interviews were audio-recorded, pseudo-anonymised and transcribed verbatim. Thematic analysis was undertaken, with code lists collaboratively and iteratively developed by the research team.Results 19 interviews were conducted (aged 44-92, 12 female);10 participants had undergone previous ERCP (9 had not), 5 had combined EUS and ERCP (14 had ERCP only). Three overarching themes were identified in the data.Communication: there was variation in participants’ attitudes towards communication regarding pre-procedure information, complications and post-procedure information. Most participants described feeling well-informed at the time of the procedure but upon reflection, did not fully understand the severity of the procedure and complications. The timing of communicating the risks of the procedure and the subsequent results were commonly raised as a concern.Experiential nature of ERCP: participants described a mismatch between their expectations of sedation and their actual experiences. Although most anticipated feeling relaxed, some awoke with no memory of the procedure, while others remained fully aware throughout and described finding this unexpectedly distressing.Trust, apprehension and vulnerability: some participants were nervous about the procedure and outcomes, whereas others placed full trust in clinicians. Some participants felt powerless during the consent process due to the timing of risk discussion. Others felt vulnerable during the procedure, particularly in relation to the suppository.Conclusions This study has shown that patient experiences of ERCP are shaped by the quality, clarity and timing of communication, as well as feelings of trust and vulnerability. Many of the concerns raised by participants, appear easily addressable with clearer, earlier information, e.g. anxiety resulting from uncertainty of the procedure environment. The Newcastle ENDOPREM will be adapted based on these findings.