Endoscopic management of a variety of benign and malignant biliary tract diseases is now a well-established alternative to surgery. Similar techniques are now applied to the pancreas and are being used in the setting of acute pancreatitis, chronic pancreatitis, complications of pancreatitis, and pancreas divisum. This review analyzes the current state of the art of these exciting applications of endoscopy. Selection of appropriate candidates for the various treatment modalities appears important for optimal results of therapy. However, definite recommendations are difficult to make because there are limited controlled studies, follow-up in most series is brief, and there are no comparison studies of endoscopic versus surgical therapy. At present, careful case selection and conservatism are the appropriate general rule in these therapeutic endeavors. Further prospective random studies are awaited.