We describe our experience between 1985 and 1989 with 24 patients with clinically significant pancreatitis after endoscopic retrograde cholangiopancreatography. The resulting pancreatitis was categorized into three groups, all requiring hospitalization: (1) mild pancreatitis (n = 12); (2) moderate pancreatitis requiring aggressive evaluation, treatment, and follow-up (n = 6); and (3) severe pancreatitis requiring surgical therapy (n = 6). The average length of hospitalization for the entire group was 12.8 days. Surgical intervention was required in 5 patients, and 3 patients died of acute necrotizing pancreatitis with sepsis, adult respiratory distress syndrome, and intractable hemodynamic failure. Our experience with this entity suggests that this form of pancreatitis includes severe and even lethal outcomes. It was associated with a mortality of 13%.