Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for radiological visualization of the common bile duct. In addition to its diagnostic applications, ERCP, along with sphincterotomy, is a standard therapy for bile duct calculi. The advent of laparoscopic cholecystectomy (LC) has focused much attention on the role of ERCP in the management of bile duct calculi. The use of ERCP before LC should be selective, with ERCP restricted to patients with a high risk of bile duct calculi. ERCP should be performed after LC in patients with continuing symptoms suggestive of bile duct calculi or when operative cholangiography has demonstrated calculi. Intravenous cholangiography (IVC) has no role as a screening test for bile duct calculi, and percutaneous transhepatic cholangiography (PTC) should be restricted to those patients in whom bile duct calculi is highly suspected and in whom ERCP has failed. Elderly and frail patients with bile duct calculi may be satisfactorily managed by ERCP alone. Although a "minimally invasive" procedure, ERCP is not without risks. Local practice will depend to a great extent on the availability of ERCP expertise.
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