Objective: To review the experience of using endoscopic retrograde cholangio-pancreatography (ERCP) in the clinical diagnosis and treatment of biliary complications during perioperative period of primary liver cancer at our hospital. Methods: A retrospective analysis was conducted on the clinical data of patients undergoing ERCP treatment for biliary complications during perioperative period of primary liver cancer at our hospital from October 2016 to June 2023. According to the indications of ERCP for biliary complications, the cases were divided into bile duct tumor thrombus group, bile duct stricture group, and bile leakage group. The baseline data, laboratory test results before and after ERCP treatment, treatment outcomes, and other datas of the patients with different types of biliary complication were statistically analyzed. Results: A total of 25 patients underwent 25 cases of ERCP, among which 23 patients were successfully cannulated, with a success rate of 92.0%. There were 14 cases of bile duct stenosis, mainly treated with biliary balloon dilation, probe dilation, stent implantation, and nasobiliary drainage; 6 cases of bile leakage, mainly treated with stent implantation and nasobiliary drainage; 5 cases of bile duct tumor thrombus, mainly treated with net basket and balloon thrombectomy, stent implantation, and nasobiliary drainage. After ERCP treatment, the patient's serum total bilirubin, serum direct bilirubin, and γ-glutamyl transferase significantly decreased compared to those before the treatment (P<0.05). The postoperative average amylase was (85.0±69.4)(21-306) U/L. No bleeding, gastrointestinal perforation, pancreatitis, or other ERCP-related complications occurred in all cases. Conclusions: Bile duct stricture is the most common biliary complication during the perioperative period of primary liver cancer. For these patients with biliary complications during perioperative period of primary liver cancer ERCP treatment is safe and effective.