Acute pancreatitis remains a frequent gastroenterologic disorder and is still burdened with a significant mortality. Alcohol abuse and gallstone disease remain the principal causes of pancreatitis but recent studies indicate that over 70% of patients with so-called idiopathic pancreatitis also have some form of biliary tract disorder. New techniques like endoscopic sphincterotomy, lithotripsy, and laparoscopic cholecystectomy offer new alternatives to treat the underlying gallstone disease in pancreatitis patients. The debate about anatomical variants as predisposing factors for pancreatitis continues and specific therapeutic agents are still not available.