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Endoscopic retrograde cholangiopancreatography (ERCP) is a unique specialty tool used for the diagnosis and treatment of biliary and pancreatic disease. The procedure is much more available now and can be used in place of surgery or in conjunction with surgery. This article reviews the indications, applications, and personal experiences with the procedure in a rural referral hospital. Discussion includes the risks and complications of ERCP. Also included are explanations of therapeutic interventions. After reading this article, primary care physicians should have greater familiarity with the utility of this endoscopic tool.