This year, 2023, marks the fiftieth anniversary of the introduction of therapeutic endoscopic retrograde cholangiopancreatography (ERCP), which completely changed the management of biliary and pancreatic diseases. As in other invasive procedures, two intrinsically related concepts soon appeared: drainage success and complications. It was observed that ERCP is the most dangerous procedure regularly performed by gastrointestinal endoscopists, with a morbidity and mortality of 5-10 % and 0.1-1 %, respectively. ERCP is by far one of the best examples of a complex endoscopic technique.