ERCP is an important armamentarium in the management of pancreaticobiliary disorders and as happens with any invasive procedure ERCP too is associated with complications. These range from general adverse events related to any endoscopic procedures to unique adverse events like post-ERCP pancreatitis. Complications can cause significant morbidity and even mortality [1] and hence prevention and management of ERCP complications are of utmost importance. In spite of advances in technology, operator skills, and safety protocols, the incidence of adverse events related to ERCP remains constant [2]. Early recognition and proper management are crucial for improving outcomes after post-ERCP complications. The most common complications of ERCP are pancreatitis, bleeding, perforation, cholangitis, and sedation-related adverse events (Table 1). Prompt recognition and proactive management with effective strategies can help reduce morbidity and mortality. It is also important to recognize other uncommon complications like impaction of the stone retrieval basket, post-ERCP strictures, air embolism, etc (Table 1). Awareness and a high index of suspicion are required to identify and promptly manage these rarer complications [3,4].

In the review, we shall discuss the management of common and relatively uncommon complications related to ERCP. We shall discuss how to risk stratify and systematically manage these complications using algorithmic approaches.