Background and Aims: Acute biliary pancreatitis (ABP) is a common disease and its most common cause is choledocholithiasis. At present, the mainstream view in China is that endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) should be performed as early as possible for diagnosis and treatment of the early-onset ABP. However, the recent literature and guidelines demonstrated that ERCP combined with EST are not suitable for all ABP patients. Therefore, concerning this issue, this study was conducted to further investigate the clinical value and clinical indications of ERCP plus EST in treatment of ABP. 
Methods: The clinical data of 107 patients admitted for ABP from January 2016 to January 2019 were retro-spectively analyzed. Of the patients, 47 cases underwent conservative treatment, and the other 60 cases received ERCP plus EST within 72 h of admission on the basis of conservative treatment. The clinical efficacy variables of the two treatment methods were compared.
Results: Results of the overall analysis showed that ERCP plus EST was significantly superior to conservative treatment in terms of abdominal pain relief time, CRP recovery time and blood amylase recovery time (all P<0.05). Further subgroup analysis indicated that ERCP plus EST was significantly better than conservative treatment in abdominal pain relief time, leukocyte recovery time, CRP recovery time, blood amylase recovery time and average  hospitalization time for ABP patients with concomitant acute cholangitis (all P<0.05), but had no obvious advantages over conservative treatment in each observed variable for ABP patients without acute cholangitis (all P>0.05). In either overall analysis or subgroup analysis, the hospitalization costs of ERCP plus EST were significantly higher than those of conservative treatment (all P<0.05), while no significant differences in the incidence rates of complications were noted between the two treatment methods (all P>0.05). 
Conclusion: For ABP, ERCP plus EST has certain advantages over conservative treatment, and especially for ABP with concomitant acute cholangitis, has demonstrable efficacy. However, ERCP plus EST has no sig-nificant superiorities to conservative treatment for ABP without cholangitis, instead it increases the hospitalization costs. Therefore, the patient's condition should be comprehensively analyzed in clinical practice, which cannot be treated uniformly. The individualized treatment plan is recommended.