Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial technique for the diagnosis and treatment of biliary and pancreatic diseases. However, after gastrointestinal reconstruction surgery, the input loop is often longer, making it difficult to reach the duodenal papilla or the biliary/pancreatic enteric anastomosis, resulting in a low success rate of ERCP. Common gastrointestinal reconstruction surgeries include pancreaticoduodenectomy, Roux-en-Y gastric bypass, Roux-en-Y total gastrectomy, and Roux-en-Y cholangiojejunostomy. With the advancement of technology, balloon-assisted enteroscopy, endoscopic ultrasound, and laparoscopy have all been used for ERCP after gastrointestinal reconstruction surgery.Among these, the success rate of ERCP assisted by enteroscopy has been continuously increasing, reaching 70%-90%. It is the most physiological approach, hence recommended by guidelines as the first choice for ERCP after gastrointestinal reconstruction surgery. If enteroscopy-assisted ERCP fails, techniques such as endoscopic ultrasound guided biliary/pancreatic duct drainage (EUS-BD/PD) or laparoscopy-assisted ERCP can be considered as secondary treatments.