Eleven patients with gallstone-related acute pancreatitis underwent urgent duodenoscopy and diathermy sphincterotomy; 6 had stones impacted at the papilla of Vater and the remainder had stones in the bile duct. One patient had a gallstone in the pancreatic duct. Endoscopic removal of the duct stones resulted in a prompt, persistent clinical and biochemical improvement, except in 1 patient who was referred from another hospital with a pseudocyst 3 wk after the onset of illness. Pancreatography results were remarkably normal in the remaining patients. Use of emergency biliary decompression in patients with acute gallstone-related pancreatitis remains controversial and the indications need clarification. Further evaluation of duodenoscopic sphincterotomy as an alternative to surgery is emphasized.