Objective To explore the clinical value of ERCP combined with MRI in the diagnosis of pancreaticobiliary diseases. Methods Ninety patients with pancreaticobiliary diseases who were admitted into our hospital between January 2015 and January 2016 were examined by ERCP and MRI examination. All patients were confirmed by surgery, biopsy and pathology. There were 45 cases with choledocholithiasis, 20 cases with pancreatic cancer, 12 cases with bile duct carcinoma complicated with obstruction, 8 cases with chronic pancreatitis and 5 cases with biliary tract roundworm infection. The clinical manifestations included jaundice, repeated upper abdominal pain, nausea and vomiting. Results The accuracy rates of ERCP in the diagnosis of choledocholithiasis, pancreatic cancer, bile duct carcinoma with obstruction, chronic pancreatitis and biliary tract roundworm infection were 95.56%, 100%, 75.00%, 87.50% and 100% while those of MRI were 86.67%, 85.00%, 75.00%, 87.50% and 80.00%. The accuracy rate of ERCP in the diagnosis of pancreaticobiliary diseases was slightly higher than that of MRI but there was no statistical difference (P>0.05). The ERCP and MRI features of pancreaticobiliary diseases were different. Conclusion ERCP and MRI have high consistency in the diagnosis of pancreaticobiliary diseases. The combined application of the two can greatly improve the accuracy of diagnosis and both of the two can be used as complementary diagnosis according to the imaging features.