The clinical implications of a diseased papilla at endoscopic retrograde cholangiopancreatography (ERCP) are ambiguous. Is the diseased appearance caused by inflammation or tumor? Is there stenosis? Could papillary disease be the consequence of pathology elsewhere in the biliary–pancreatic tract? What should be the next step? Of 17 patients with a “diseased papilla” among 284 consecutive patients who underwent ERCP for customary indications, 10 had papillitis [inflamed papilla] confirmed. The two major associations of papillitis were common bile duct stones (50%) and biliary or pancreatic surgery (40%). Cholestatic jaundice (60%) and pain (50%) were the major presenting symptoms of papillitis. Six patients had tumor with progressive jaundice (83%). Visually and cholangiographically, it may be difficult to distinguish papillitis from tumor. These concepts will be helpful in the evaluation and management of patients who have a “diseased papilla”. Do they sound like wild tales?