Endoscopic retrograde cholangiopancreatography remains an important tool for the management of biliary and pancreatic disease. Endoscopic removal of common bile duct stones is the procedure of choice for retained stones and is a common option preoperatively with the gallbladder in place. Cholangitis is best treated by endoscopic sphincterotomy and stenting along with intravenous antibiotics initially with the possibility of definitive treatment with endoscopic stone removal and/or dilatation and stenting for strictures. Endoscopic sphincterotomy is also recommended in severe or rapidly worsening gallstone pancreatitis or in those with combined pancreatitis and rising bilirubin or cholangitis. Palliation with internal stents for malignant strictures has been possible with good outcome and very little difference in efficacy, complications, mortality, and long-term survival compared to surgical treatment. Biliary fistulae are easily treated by endoscopic stenting, particularly when the source is the cystic or an accessory duct. Benign biliary strictures can be dilated and stented for prolonged periods with good long-term success in selected cases. Pancreatic stenting is useful to treat pancreatic duct strictures and duct hypertension with considerable improvement of pain. Endoscopic drainage of pancreatic pseudocyst appears to be a safe, effective, and definitive treatment for patients in whom anatomic considerations allow its use. In summary, therapeutic uses of ERCP are of broad interest to the general surgeon and should be understood and utilized appropriately by the surgical community.