This review focuses on the medical and endoscopic approachs to patients with acute mild or severe pancreatitis. Acute pancreatitis is an acute inflammatory process of the pancreas whose the main determinant of the outcome is the extent of pancreatic necrosis. After the diagnosis, a severity assessment using scoring systems and early contrast enhanced Computed Tomography should be performed in all patients within 48 hours from the admission. All cases of severe acute pancreatitis should be managed initially in intensive care units with full systems support. Patients with gallstone pancreatitis should have definitive Endoscopic Retrograde Colangio-Pancreatography (ERCP) or surgical management of the gallstones.