Endoscopic retrograde cholangiopancreatography (ERCP) has become an effective and safe therapeutic method, providing clinical success in more than 80% of cases. As ERCP has evolved from a diagnostic to a therapeutic procedure, technical demands have risen. Furthermore, it is an invasive procedure that can be potentially harmful when administered improperly. Quality of ERCP and procedural outcome are dependent on various factors that are related to the patient, procedure, and endoscopist. These factors are reviewed in detail and their contribution to ERCP quality is presented and discussed. Preventive therapies through procedural techniques and medical management to avoid complications are available. Proper and organised training and ERCP outcome reporting are essential for further quality improvement.
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