Endoscopic pancreatic therapy is emerging as an exciting nonoperative alternative in the management of chronic pancreatitis, in particular in cases where pancreatic duct obstruction due to stones, protein plugs, or strictures is present. Although the preliminary results available are promising, prospective randomized trials comparing endoscopic and surgical techniques are much needed. Furthermore, the published data come from large endoscopic centers with very high levels of technical skill and experience, and, therefore, its wide-spread clinical use is limited. Time and well-designed prospective randomized clinical trials comparing surgical versus endoscopic techniques will help define the role of these procedures in the treatment of chronic pancreatitis.