Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique in which a specialized side-viewing upper endoscope is guided into the duodenum, allowing for instruments to be passed into the bile and pancreatic ducts. These are opacified by injection of a contrast medium, thereby permitting their visualization and allowing for a variety of therapeutic interventions. It is a relatively complex endoscopic procedure since it requires specialized equipment and has a long learning curve to develop proficiency. Its benefits in the minimally invasive management of biliary and pancreatic disorders are challenged by a higher potential for serious complications than any other standard endoscopic technique.
Similar to other endoscopic procedures, determinants of ERCP procedural safety include :
- Indication (appropriate or questionable)
- Sedation and monitoring practice
- Patient age and clinical condition
- Specific procedures performed (diagnostic or therapeutic)
- Setting and equipment of the endoscopy unit
- Training and competence of endoscopist and endoscopic team
At least 180 procedures are required for a trainee to acquire a level of competence in diagnostic and therapeutic ERCP, defined by deep cannulation of the bile duct in 70 to 80 percent of cases . This is still below the optimal standard of 90 to 95 percent success when the procedure is performed by experts . An adequate volume of activity is also needed to maintain proficiency. Individual endoscopists who perform more than 40 endoscopic sphincterotomies per year  or at least one per week  have a lower complication rate than those who perform fewer procedures.
This topic will review the indications for ERCP and will provide an overview of the complications associated with diagnostic and therapeutic ERCP, including their definition, classification, incidence, and risk factors. Specific complications of ERCP and biliary sphincterotomy are discussed in detail separately. (See "Post-endoscopic retrograde cholangiopancreatography (ERCP) septic complications" and "Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis" and "Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding" and "Post-ERCP perforation" and "Rare complications of ERCP".)