Background: DACP, as an adjunct to ERCP allows for direct visualization of the biliary duct and pancreatic duct.We aim to assess the technical feasibility of DACP for a variety of clinical indications and to determine its impact on disease management. Methods: 94 consecutive DACP examinations were performed in 57 patients with 3 groups of disorders, choledocholithiasis (CDL), biliary strictures(BS) and pancreatic disease(PD), age range (24 to 91 years; mean 69). All DACPs were performed using the Pentax FCP-8P or 9P. Data pertaining to indication, technical success, and clinical impact of DACP on disease management were collected and analyzed using cMore endoscopic database. Results: CDL (n=53, 27 pts ) Indications included stone fragmentation using EHL (n=34), evaluation of biliary tree post-stone removal (n=14), distinction between stone and stricture, evaluation of biliary tree for stones despite normal cholangiogram (n=5). Technical success was achieved in 29/53 DACPs. The 24/53 failures represent partial fragmentation of stones with EHL in 8 patients with extensive disease. Use of DACP resulted in complete removal of biliary tree stones in 10/34 examinations (10 patients) and demonstrated the presence of stones in 4 patients with normal post-interventional cholangiograms. Furthermore DACP helped to confirm the absence of stones after removal by basket or balloon in 11/12 patients. BS (n=33, 23 pts) Indications included evaluation of stricture(n=21) or Wallstent occlusion (n=4), and monitoring of cholangiocarcinoma progression in a single patient (n=7). Technical success was achieved in 29/33 cases. DACP assisted in confirming or clarifying the nature of a stricture in 16/29 cases, and in stent management in 20/29 cases. PD (n=7) Indications included evaluation of pancreatic duct obstruction in chronic pancreatitis (n=4) and malignancy (n=1), and evaluation of PD for IPMT (n=2). An additional use of DACP was in the evaluation of hemobilia (n=1) where no source was seen. There were no complications reported with the use of DACP. Conclusion: DACP is technically feasible in the management of pancreatico-biliary diseases. Lack of complete technical success in the use of EHL to fragment stones is due to extensive stone disease in a limited number of patients. Otherwise DACP impacts on the management of complicated biliary tract disease by clarifying cholangiograms, assisting in EHL stone fragmentation, and guiding stenting and surgical management.