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The number of patients undergoing digestive surgery with altered anatomy has been steadily increasing for several years. This increase is driven by two types of surgery: oncological and bariatric surgery. Most of these surgeries alter conventional endoluminal access with a duodenoscope to the bile ducts or the main pancreatic duct. The first descriptions of retrograde endoluminal access using an enteroscope date back to the 1990s. The use of an enteroscope (double or single balloon) allows deep progression into the intestinal limb to reach papilla or bile ducts or the pancreatic duct. In the literature, the technical success rate of entero-ERCP (ERCP: endoscopic retrograde cholangiopancreatography) varies greatly, from 40% to 90%, depending on the type of altered anatomy, the operator’s experience, the level of training, and the equipment available. There appears to be an East–West gradient in effectiveness, with technical success rates close to 90% for Japanese teams and below 70% for American teams. Nevertheless, in expert hands, entero-ERCP is technically and clinically effective and is associated with a low morbidity and mortality rate. With the advent of therapeutic echoendoscopy and the creation of echoendoscopy-guided anastomosis, the usefulness of entero-ERCP is being questioned in the medical community. This examination, considered tedious, time-consuming, and challenging, is being abandoned in favor of echoendoscopic solutions associated with significant adverse events. In reality, therapeutic echoendoscopy and entero-ERCP should be seen as complementary techniques rather than rivals. However, before embarking on entero-ERCP, knowledge of surgical procedures and comprehensive endoscopic training in ERCP and enteroscopy techniques are necessary in order to achieve optimal technical efficacy similar to that of Japanese teams.