The problems with total serum amylase as the primary test to diagnose acute pancreatitis continue to appear. Although lipase is emerging as the single best test to select for diagnosing acute pancreatitis, specificity problems, especially with the frequently utilized Ektachem (Eastman Kodak Co., Rochester, NY) assay, have not been generally appreciated. Currently, polymorphonuclear elastase appears to be the serum marker of choice for predicting clinical outcome of patients with acute pancreatitis, while phospholipase A2is falling out of favor. Pancreatic endocrine maximal stimulation tests may help the clinician diagnose patients with mild to moderate chronic pancreatitis.