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Endoscopic retrograde cholangiopancreatography (ERCP) is the established immediate treatment for a number of biliary pathologies, including obstructing gallstones and a range of malignancies. It is an essential life-saving procedure for biliary sepsis and acute pancreatitis, and for the palliation of biliary obstruction resulting from advanced malignancies. It is recognized that the displacement of routine care during the COVID crisis is continuing to place an unprecedented strain on all aspects of national healthcare organizations, including the National Health Service (NHS) 1. The authors’ unit is currently the highest-volume ERCP centre in the UK, with almost 1000 ERCPs annually and a higher than average rate of day-case procedures 2. This unit’s outcomes were reviewed for two consecutive patient cohorts undergoing ERCP during the first COVID-19 peak between March and May 2020, and during the …