Since its inception and initial application in the early 1970s, endoscopic therapy has revolutionized the approach to a variety of biliary tract disorders. Before that time, interventional management of hepatobiliary and pancreatic diseases was primarily surgical. The capability of rendering definitive therapy at endoscopic retrograde cholangiopancreatography (ERCP) was the first development in the current movement of minimally invasive treatment. Innovations in instrumentation and refinements in technique rapidly ensued once the enormous potential of ERCP was appreciated. Paralleling these advances was a critical assessment of the application of ERCP. The cornerstone of therapeutic ERCP, endoscopic sphincterotomy, emerged relatively rapidly as the preferred management of common duct stones among patients who had undergone cholecystectomy. Techniques learned in the management of stones were rapidly and effectively used to treat patients with benign and malignant biliary strictures, gallstone pancreatitis, acute cholangitis, biliary fistulas, sphincter of Oddi dysfunction, and rarer problems, such as sump syndrome and biliary infestation with parasites.
Although the first pancreatic sphincterotomy was performed in 1976, ERCP was used primarily as a diagnostic modality in the setting of pancreatic disease because of concerns about prohibitive morbidity rates. Once the relative safety of ERCP and endoscopic sphincterotomy in the setting of gallstone pancreatitis was recognized, the indications for endoscopic therapy for pancreatic disorders were expanded. Endoscopic therapy is being applied in the setting of acute pancreatitis, chronic pancreatitis, complications of acute and chronic pancreatitis, pancreas divisum, and pancreatic and ampullary tumors. The role of therapeutic ERCP in the treatment of patients with pancreatic disease is still evolving. More experience is needed to determine the place of this modality in these patients' care.