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Despite the technical advancement in the last two decades, there is still considerable variation in the manner of management of choledocholithiasis in different countries. This study aims to assess the national pattern of endoscopic retrograde cholangiopancreatography (ERCP) in the management of choledocholithiasis in India in comparison with the US experience. A nation-wide cross-sectional survey of ERCP practice was conducted in two tertiary care institutions (National Institute of Liver and Biliary Sciences, New Delhi and Pramukhswami Medical College, Ahmedabad) and 54 regional centres from 28 states of India, over a period of 6 months. Data was collected on 8 variables. The overall compliance with the American Society of Gastrointestinal Endoscopy (ASGE) guidelines was calculated. The National ERCP Registry of the above two tertiary centres showed that a total of 6,446 (62 % male, 38 % female) cases of ERCP were done in the last 6 months, with acceptable compliance with the ASGE guidelines. A total of 2,854 (40 %) patients underwent diagnostic ERCP only (group A). Of these diagnostic ERCP cases, 25.5 % were diagnostic with biliary cannulation (group B1). Of the cases where therapeutic ERCP was done, 2,735 (38 %) had sphincterotomy (group B2) and 1,868 (26.5 %) had endoscopic papillary balloon dilatation. The percentage of therapeutic ERCP for patients of cholelithiasis has increased from 65 to 87 % in the last 20 years. In this study,
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