Introduction: ERCP is the primary treatment for benign and malignant pancreatic-biliary diseases. Procedure success and safety depend on indication. The research examined how endoscopic presence of the main duodenal papilla affects ERCP bile duct cannulation. Method: 226 cases This study included adult Iraqi male and female hospitalised patients over 18. These individuals seek hospital ERCP for extrahepatic biliary blockage from various causes. The incidence of problematic cannulation and the correlation of papilla type with age, gender, underlying diagnosis, and acute problems were the main outcome measures. Results: This research includes 226 male and female subjects over 18. 87 (38.5%) male, 139 (61.5%) female, aged 19–101. 86.5% (n=96) of female type 1 and type 4 papilla patients had common bile duct stones. Most ERCPs were for common bile duct stones (72.6%). Type 1 ampulla (49%), type 2 (16.4%). Difficult biliary cannulation was 53.1% (n=120), with type 4 papilla being the hardest (92.3%; n=36) and type 1 being the easiest (83.8%; n=93). Pre-cuts were done in 36.3% (n=82) of instances, largely with type 4 papilla (76.9%; n=30) and acute complications in 15% (n=34), predominantly bleeding (97.1%; n=33) and mostly with type 2 (32.4%; n=12). Conclusion: the gender of patient and underlying diagnosis associated with shape of papilla while the age not. Type 1 papilla is the most common type. The shape of papilla significantly affects the difficulty of biliary cannulation, the use of pre cut and immediate complications.