[Papillotomy in acute pancreatitis: has the last word been spoken?]

It is meanwhile generally accepted that endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (EST) can be performed in acute pancreatitis without major complications. However, it is still unsettled if these techniques are useful in the treatment of patients with acute pancreatitis. Based on the available data ERC is obviously the best technique to define a biliary origin of acute pancreatitis. If biliary pancreatitis is suspected, there is an indication for short-term ERC and EST most probably only in patients with severe disease or difficult prognosis or suspicion of cholangitis, while in uncomplicated mild disease the treatment can be elective. In nonbiliary acute pancreatitis EST does not provide any advantage for the patient.