The purpose of this study was to review the indications, technical success, complications, and overall outcomes of ERCP procedures performed at our center.

A total of 864 patients were initially considered for inclusion, of whom 58 were excluded because ERCP could not be completed (technical inability, patient instability, or early termination). Ultimately, 806 patients who underwent ERCP between January 2024 and September 2025 were included in the analysis.

The age range of the 806 patients was 18–100 years, with a mean age of 71.26 years. Among women, the mean age was 71.42 years (range 18–97), while among men it was 71.99 years (range 20–100). The cohort consisted of 390 women (48.4%) and 416 men (51.6%).

ERCP indications included: confirmed or suspected common bile duct stones (CBDS), biliary strictures, sepsis/cholangitis, pancreatic mass with jaundice, scheduled follow-up after previous ERCP, cholangiocarcinoma, acute pancreatitis, suspected postoperative bile leak, stent dysfunction, liver mass with jaundice, ampullary mass with jaundice, sclerosing cholangitis, and papillary narrowing suggestive of sphincteritis. Cannulation of the common bile duct (CBD) was successful in 799 patients (99.13%), while pancreatic duct cannulation was achieved in 127 patients (15.75%). Both ducts were cannulated in 122 patients (15.13%); two patients could not be cannulated. Among the 127 pancreatic duct cannulations, 88 (69.29%) were successful on the first attempt, 27 (21.26%) on the second attempt, and 12 (9.45%) required more than three attempts. Regarding cannulation techniques, 714 patients (88.8%) underwent wire-guided cannulation, 26 (3.2%) underwent pre-cut access, and 64 (8%) underwent transpancreatic sphincterotomy. Prior sphincterotomy was present in 246 patients (30.6%), while conventional sphincterotomy was performed in 468 (58.2%), transpancreatic sphincterotomy in 64 (8%), and pre-cut in 26 (3.2%).Among the 799 patients with successful biliary cannulation, 508 (63.18%) had CBD stones, 52 (6.46%) had biliary sludge, 232 (28.85%) had ductal dilation, 210 (26.11%) had strictures, 11 (1.37%) showed bile leakage, and 7 (8.70%) had purulent bile. In 36 cases (4.47%), no CBD pathology was detected. Additional findings included one patient with sphincter of Oddi dysfunction (ODS), one with stent migration, one with a cholecystoenteric fistula. Benign strictures were identified as follows: 15 (7.14%) in the common hepatic duct, 37 (17.61%) in the CBD, 12 (5.71%) at the ampulla, 4 (1.9%) at the hepatic hilum, and one in the left hepatic duct. Malignant strictures included: 19 (9.04%) in the common hepatic duct, 39 (18.57%) in the CBD, 7 (3.33%) at the ampulla, 11 (5.2%) at the hilum, two in the left hepatic duct, and one in the right hepatic duct. Ductal dilation was documented in 80 patients (34.48%) in the common hepatic duct, 186 (80.17%) in the CBD, 54 (23.27%) at the hilum, 52 (22.4%) in the left hepatic duct, 49 (21.12%) in the right duct, and 2 at the ampulla. Patients with CBD stones underwent stone extraction and/or placement of a plastic biliary stent. Stents were also placed in patients with pancreatic head tumors, CBD tumors, bile leaks, and CBD strictures. Endoscopic biopsy was performed in all patients with suspected ampullary tumors. Procedure duration ranged from 15 to 48 minutes. The overall complication rate was 7.9%. After ERCP, 14 patients (1.7%) developed severe cholangitis and 19 (2.4%) developed severe acute pancreatitis. Bleeding requiring endoscopic therapy occurred in 6 patients (0.7%), while 7 patients (0.8%) had minor bleeding (hemoglobin drop <3 g/dL without transfusion). Moderate bleeding requiring transfusion (≤4 units) occurred in 3 patients (0.3%). Perforation occurred in 2 patients (0.9%).

ERCP is a complex endoscopic intervention requiring specialized expertise and equipment. Optimizing patient selection and identifying risk factors are essential for minimizing complications. Unnecessary diagnostic ERCP should be avoided, especially in patients with low likelihood of biliary stones or strictures, normal bilirubin, or absence of clinical signs of biliary disease. The use of non-invasive imaging modalities whenever possible can significantly reduce ERCP-related adverse events.