ERCP is usally performed under intravenous analgosedation (AS). In particular cases examinations or planned interventions have to be terminated prematurely due to inadequate sedation. In cases of difficult anatomy supine position is useful. Supine position requires intubation for airway protection. Methods: In the present study we compared the extent and efficacy of examinations performed under general anesthesia (GA)and AS. 20 ERPCs under AS and GA (10m, 10f) were analyzed. ERCPs under AS were carried out in left position, ERCPs under GA in supine position. Results: Patients who received GA were younger compared to patients who received AS (40 vs. 51 years mean). The underlying diseases were distributed similary. In the GA group interventions were more extensive. Indications for GA were: prematurely terminated ERCP under AS due to inadequate sedation (n=10), intubation for airway protection and achievment of ideal examination conditions (n=10). To identify risk factors, the ASA-(American Society of Anesthesiologists) classification was used. Both groups showed the mean ASA-grade 2. All patients were recovered from GA without incidents with postoperative extubation at a mean time of 8.7 min after termination of ERCP. The recovery time until PARS (post anesthesia recovery score) >9 achieved did not differ between the groups examined (AS vs. GA: 12.1 vs. 13.0 min, p=0.20). In comparison to AS, more interventions were performed under GA (2.4 vs. 1.7). The duration of ERCP under GA was 25 min prolonged (GA vs. AS: 59 vs. 34 min). All ERCP performed under GA were successful, whereas 2 examinations under AS had to be terminated prematuraly due to inadequate sedation. The endoscopic procedure was not impaired by monitoring, oral intubation, mechanical ventilation and supine position. Discussion: Although more extensive ERCP interventions were performed, and the duration of ERCP under GA requieres more time compared to AS, recovery time did not differ. There were no complications due to the anesthetic procedure. GA allows a successful and safe completion of difficult ERCPs.