Objective To explore the efficacy of ERCP in the treatment of biliary fistula.Methods Retrospectively analysis of the clinical data of 81 patients with biliary fistula from Jan 2017 to Oct 2020 was conducted. According to the treatment, the patients were divided into observation group (n = 46) and control group (n = 35), observation group with ERCP treatment and control group with conservative treatment, compared the two groups of treatment effectiveness, incidence of complication rate, secondary surgery rate, hospitalization expense and length of hospital stay.Results Of which 95.7% were effective (44/46) in observation group, and 54.3% (19/35) in control group (P = 0.000); Two patients (4.3%) in observation group underwent secondary surgery, and 16 patients (45.7%) in control group (P = 0.000); The average length of hospital stay in observation group was (14.0 ± 6.0) d and in control group was (19.1 ± 14.6) d (P = 0.036). The average hospitalization expense was (40 368.8±12 114.5) in observation group and (59 531.2±17 448.8) in control group (P = 0.000). In the observation group, the recovery time was (1.4 ± 0.7) months, while in the control group, the recovery time was (1.8 ± 0.7) months (P = 0.044). 12 patients (26.1%) in the observation group had postoperative complications, while 6 patients (17.1%) in control group (P = 0.337).Conclusion ERCP treatment was more effective than conservative treatment, the rate of secondary surgery was lower, the length of hospitalization and the cost of hospitalization were relatively less. But there was no significant difference in incidence of complications rate.