Endoscopic treatment of acute biliary pancreatitis is restricted to the treatment of bile duct stones. Three prospective randomized trials demonstrate the superiority of early ERCP/papillotomy (within 96 h) over conservative treatment of severe acute biliary pancreatitis, as well as safety and effectivity of the endoscopic procedure. The timing of the early ERCP/papillotomy (emergency vs. within 96 h) is at discussion. Although no significant benefit of immediate and early ERCP/papillotomy over the conservative approach has been shown in cases of predicted mild acute pancreatitis, the Hong Kong group advocates this procedure independent of the severity of the disease. We prefer this latter approach because potentially lethal complications are treated in time, papillotomy prevents further ampullary occlusion by stones and may early relieve pancreatic duct hypertension.