World-wide, gallstones are the commonest cause of acute pancreatitis (AP), a potentially life-threatening condition. Scoring systems based on radiologic findings and serologic markers help predict which patients may have retained bile duct stones. Endoscopic decompression of the biliary tree (by sphincterotomy and stone extraction during ERCP) is safer than surgery, which carries high morbidity and mortality in AP. Four prospective, randomized clinical trials confirm the utility of this approach, however careful patient selection is necessary. Medical therapy for AP is supportive; no agent or medical intervention has been shown consistently to abort or ameliorate the course of AP. Drugs that inhibit inflammatory cytokine production, however, are showing promise.