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Discussion. The indications for ERCP are covered in detail in a separate publication (9) and are summarized in Table 2. Clinical settings in which ERCP is generally not indicated include the following:(1) Abdominal pain without objective evidence of pancreaticobiliary disease by laboratory or noninvasive imaging studies (10). In this setting the yield is very low, yet the risk of complications is significant (11). When considered in this patient group, ERCP should only be undertaken in a setting capable of performing sphincter of Oddi manometry (12).(2) As a routine before cholecystectomy. Preoperative ERCP should be reserved for patients with cholangitis or a significant likelihood of biliary obstruction or duct stones by clinical criteria (13) or imaging studies.(3) As a routine for relief of biliary obstruction in patients with potentially resectable malignant distal bile duct obstruction. Preoperative biliary decompression has …