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Advances in imaging modalities have led to increased detection of intraductal lesions in the biliopancreatic system, presenting therapeutic dilemmas between the risks of surgical overtreatment and the consequences of delayed intervention. This multicentre Chinese case series of 20 patients (13 with gall bladder, 5 with bile duct (BD) and 2 with pancreatic duct (PD) lesions) demonstrates the feasibility and safety of cholangiopancreatoscopy-assisted endoscopic mucosal resection (CA-EMR) for both removal and histological diagnosis of these lesions.