Objective: To investigate the clinical value and safety of endoscopic therapy for acute biliary pancreatitis (ABP) during pregnancy. Methods: The clinical data of 35 women with ABP treated from 2000 to 2014 were retrospectively analyzed. Of the patients, 13 cases received conservative treatment (conservative group), and the other 22 cases received minimally invasive endoscopic treatment within 48 h after definite diagnosis was made (endoscopic group). Results: In conservative group, 9 pregnant women (69.2%) were cured, 4 pregnant women (30.8%) died, and fetal death occurred in 6 cases (46.2%). In endoscopic group, 19 pregnant women (86.4%) were cured, of whom 12 cases were cured by endoscopic sphincterotomy (EST), 2 cases were cured by endoscopic nasobiliary drainage (ENBD) and 4 cases were cured by laparoscopic treatment after ENBD, and one case whose condition worsened after endoscopic treatment underwent emergent open surgery and termination of pregnancy, and then recovered but the fetus died; 3 pregnant women (13.6%) died, of whom one case underwent open conversion due to failure of endoscopic treatment, and then developed pancreatic fistula that caused both maternal and fetal death, and 2 cases developed multiple organ failure that caused both maternal and fetal death. The maternal and fetal mortality in endoscopic group were significantly lower than those in conservative group (both P<0.05), moreover, the degree of improvement of laboratory parameters in endoscopic group was better than that in conservative group at 3 d after treatment (all P<0.05). Conclusion: Early endoscopic intervention for ABP patients during pregnancy is safe and effective.