To assess the diagnostic and therapeutic performance of ERCP in the management of intrabiliary rupture of hepatic hydatid cysts.

We retrospectively included 60 patients with liver hydatid cysts fistulized into the bile ducts, treated between January 2016 and September 2025.Overall success was defined as complete clearance of the common bile duct. Statistical analysis was performed using JAMOVI 2.0.

Among all ERCP procedures performed during the study period, 4.6% (n = 60) were indicated for a hydatid cyst communicating with the bile ducts.The median age was 46.1 ± 14.8 years, with a sex ratio of 2. ERCP was performed for acute cholangitis in 44.9% of cases and for persistent external biliary fistula in 34%.The median bile duct diameter was 10 [7–14] mm, and the median cyst diameter was 35 [27–47] mm.

Sphincterotomy was performed in 96% of patients, allowing hydatid material extraction (balloon or Dormia) in 87.8%.Naso-biliary drainage was required in 24% of cases, and biliary stent placement in 8%.

The overall success rate was 93.3% (n = 56), while 4 patients (6.7%) developed complications.Clinical improvement was reflected by resolution of jaundice within 5–10 days in most cases.

Our findings confirm that ERCP is a highly effective therapeutic option for intrabiliary rupture of liver hydatid cysts, with a high success rate, low complication rate, and excellent short-term and long-term outcomes. This minimally invasive approach represents a valuable alternative to surgery in appropriately selected patients.