Diagnostic and therapeutic endoscopic cholangio- pancreatography (ERCP) are more difficult in patients with Billroth II gastrectomy. A six-year experience including 274 ERCP in 175 Billroth II patients is reviewed. Overall diagnostic success-rate was 88.3% while a complete endoscopic treatment could be accomplished in 92.8% when indicated. Endoscopy related morbidity and mortality were 5.1% and 0 respectively, while in-hospital mortality was 2.3%. Diagnostic and therapeutic ERCP techniques in Billroth II patients are then discussed with special reference to the choice of the scope and of the accessories to perform a safe endoscopic sphincterotomy. The use of the lateral-viewing duodenoscope and of the long-nose sigmoid inverted sphincterotome (originally modified by our group) are emphasized. ERCP and endoscopic sphincterotomy in Billroth II subjects are today as safe and nearly as effective as in the non-gastrectomized patient.