Endoscopic retrograde cholangiopancreatography (ERCP) may lead to serious complications. Recently, magnetic resonance cholangiopancreatography (MRCP) has been introduced as a diagnostic alternative to ERCP. This study was initiated to document the diagnostic and therapeutic capabilities of ERCP, enabling us to compare the two techniques. Results of 567 ERCP procedures in 371 patients were reviewed. Bile duct stones were the most frequent indication for the procedure (66%). Normal duct systems (37%) and common bile duct stones (35%) were the most frequent findings. Stone extraction was performed in 97 patients. In 18 patients minor stones were left behind and in six patients open choledocholithotomy was performed. Procedure related mortality was 0.3% and 0.8% in the diagnostic and therapeutic group respectively. Five patients developed serious pancreatitis, and duodenal perforation complicated two procedures. 56% of the procedures were diagnostic and could probably have been replaced by MRCP if this technique had been available during the study period.