During the 5-year-period from July 1983 to July 1988, ERCP was performed within 48 hours after onset of clinical symptoms in 63 patients with suspected gallstone pancreatitis. In 53 patients this etiology was confirmed, and acute endoscopic papillotomy was done in 30 of these patients. ERCP seems to be a safe diagnostic procedure in acute gallstone pancreatitis, and papillotomy gives effective drainage and relief of the acute symptoms.