Background: post endoscopic retrograde cholangiopancreatography (ERCP) bleeding is a common complication and the incidence varies from 1% to 48%. It can be challenging to manage or localize the bleeder through a sideviewing endoscope. Objective: this study aimed to evaluate the risk factors of post ERCP bleeding and efficacy of endoscopic intervention therapies. Patients and Methods: this prospective randomized clinical trial was carried out on 100 consecutive patients at General Surgery Department Al-Azhar University Hospitals (Cairo) Egypt. All patients underwent ERCP, between January 2016 and August 2018, All ES procedures were performed by experienced surgeons and the decision to perform sphincterotomy was based on clinical, endoscopic, and radiologic findings. Results: comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray and pancreatitis was higher in patients who received electrocoagulation. Conclusion: clinically, endoscopic hemostasis therapy is very effective to manage post ERCP bleeding but increases the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each therapeutic modalities and appropriate management of different levels of bleeding are important.