Endoscopic retrograde cholangiopancreatography (ERCP) is an essential adjunct to modern hepatopancreatobiliary surgery. Modern non-invasive imaging modalities such as magnetic resonance cholangiopancreatography (MRCP) have now eliminated many of the diagnostic indications for which ERCP was originally conceived in the 1960s. However, in their place have arisen novel therapeutic indications for ERCP, including stenting and dilatation of biliary strictures, removal of biliary tract and pancreatic ductal stones, and management of post-operative bile leaks. Here, we trace these developments over the past six decades from the inception of ERCP in 1969 to the present. More broadly, maturing interventional endoscopic techniques have also paved the way for associated procedures to emerge, including transgastric and transduodenal stenting for various indications, and biopsy via endoscopic ultrasound. Taken together, these add powerful therapeutic and diagnostic tools to the hepatopancreatobiliary surgeon’s armamentarium.