Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most commonly performed endoscopic procedures. It provides the treating physician with both diagnostic and therapeutic options. The recent shift towards interventional uses of ERCP is largely due to the emergence of advanced imaging techniques, including magnetic resonance cholangiopancreatography and ultrasonography. With over 500,000 ERCP procedures performed yearly in the United States alone, it is important that all medical and surgical practitioners be well versed in indications, contraindications, potential complications, benefits, and alternatives to ERCP. The authors present an in-depth review of ERCP-related complications (pancreatitis, bleeding, perforation, etc) as well as special topics related to ERCP (periprocedural antibiotic use, performance of intraoperative ERCP, performance of ERCP during pregnancy, etc).