<p>This study aimed to evaluate the effects of a music intervention on anxiety, pain, and vital signs in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP). This randomized controlled trial included 70 patients who underwent ERCP at a university hospital in Türkiye between November 20, 2020, and February 11, 2021. Patients were randomly assigned to a music intervention group (Group 1, <i>n</i> = 35) or a control group (Group 2, <i>n</i> = 35). Anxiety and pain were defined as primary outcome measures, while vital signs were secondary outcome measures. Anxiety and pain were assessed using the Visual Analog Scale (VAS). Anxiety scores significantly decreased in Group 1 following ERCP compared to Group 2 (<i>p</i> = 0.003). Pain scores were lower in Group 1 at the 1st and 2nd hours after ERCP; however, no statistically significant differences were observed between the groups (<i>p</i> &gt; 0.05). No significant differences were found between the groups in heart rate, systolic blood pressure, or diastolic blood pressure at any time point (<i>p</i> &gt; 0.05). Oxygen saturation levels were statistically higher in Group 1 than in Group 2 at the 1st hour after ERCP (<i>p</i> = 0.007). These findings suggest that music intervention may be associated with reduced anxiety levels in patients undergoing ERCP and with a transient increase in oxygen saturation in the early post-procedural period. Further large-scale, multicenter randomized controlled studies are needed to confirm these findings and to clarify the role of music intervention in clinical practice.</p><p><b>Clinical trial number:</b> NCT04641052 (19 November 2020).</p>