Endoscopic retrograde cholangiopancreatography (ERCP) is a widespread technique used for the treatment of different diseases of the bile and pancreatic ducts. The technique is, however, associated with rare but potentially severe morbidity. Some of the adverse events associated with ERCP are directly linked to commonly made mistakes and can, therefore, be prevented. Here, we discuss 10 common and/or high-impact mistakes that are made during ERCP and how they can be avoided.

Cholangioscopy is a minimally invasive, endoscopic technique that allows direct visualisation of the bile ducts, facilitating both diagnostic and therapeutic interventions. It is a useful tool in managing biliary diseases, allowing characterisation and tissue acquisition for strictures of undetermined aetiology, facilitating extension assessment for biliary cancer and providing intraductal lithotripsy for complex biliary stones.

Examination of the pancreas and biliary and digestive structures by endoscopic ultrasonography (EUS) can be tricky and using it to make a diagnosis can be challenging. Understanding anatomical variations and postoperative modifications is vital when undertaking EUS, as is choosing the correct linear echoendoscope for the structures being examined (e.g. the hilum of the liver versus the tail of the pancreas). There can also be difficulties with tissue acquisition related to tumour location and internal structures, and there are situations when sampling is contraindicated. Consideration also needs to be given to the use of contrast with special settings and difficulties in differential diagnosis (pancreatic solid lesions, indeterminate biliary strictures, gastric neuroendocrine tumours). The role of EUS assessment after neoadjuvant therapy should also be considered. Here we discuss the most frequent mistakes that are made in pancreatobiliary and digestive EUS imaging. 

Pancreatic cystic neoplasms (PCN) are a frequent and clinically challenging condition. PCN prevalence increases with age and reports estimate that they may be present in 2–45% of the general population. In addition, the biological behaviour of the various types of PCN differs (ranging from benign to malignant [table 1]), requiring different surveillance and therapeutic approaches. Correct management of PCN is, therefore, critical for avoiding progression to cancer, but at the same time avoiding unneeded close and long-term follow-up, unnecessary invasive diagnostic procedures and overtreatment.