<p>Biliary pancreatitis accounts for 40–60% of acute pancreatitis cases and requires evidence-based, stage-adapted therapy. Diagnosis relies on the revised Atlanta criteria; alanine aminotransferase (ALT) &gt; 3 × normal within 48 h has &gt; 85% positive predictive value for biliary etiology. Serum lipase is the preferred diagnostic parameter due to higher specificity. The stepwise imaging algorithm comprises transabdominal ultrasound as the initial examination, followed by endoscopic ultrasound (EUS; sensitivity and specificity &gt; 95%) or magnetic resonance cholangiopancreatography (MRCP; sensitivity 92–94%) for stone confirmation prior to therapeutic intervention. Conservative baseline therapy includes moderate fluid resuscitation (1.5 ml/kg/h with balanced crystalloids in euvolemic patients), early enteral nutrition, and multimodal analgesia. Emergency ERCP (&lt; 24 h) is mandatory for concomitant acute cholangitis. In all other cases, ERCP should be performed electively and only after confirmed choledocholithiasis. The technical approach is based on wire-guided cannulation with size-adapted stone extraction; in cases of difficult anatomy or failed ERCP, EUS-guided procedures (rendezvous, biliary drainage) with success rates of 80–89% represent established rescue options. Complication management follows the interventional step-up principle: EUS-guided drainage of pseudocysts and walled-off necrosis using lumen-apposing metal stents, followed by direct endoscopic necrosectomy in cases of insufficient response. Definitive therapy consists of early cholecystectomy, which reduces biliary complication rates from 17% to 5% in mild pancreatitis; in more severe courses, cholecystectomy is typically recommended within 6–8&#xa0;weeks after discharge. Structured follow-up is essential, as up to 30% of patients develop exocrine insufficiency and up to 40% secondary diabetes.</p>