In order to study the causes of acute post-manipulative pancreatitis (APMP) and select the most effective ways to prevent it, a retrospective analysis of previous studies using various methods of prevention of APMP was performed. And also, several mechanisms for its development were proposed. The main ones: hydrostatic, chemical, allergic, enzymatic, infectious, thermal, mechanical. Regardless of the provoking factor, the initial damage to the pancreas leads to premature activation of proteolytic enzymes and its self-digestion with subsequent clinical manifestation of acute pancreatitis. Accordingly, preventive measures focus on one or more mechanisms. These include preventing a violation of the outflow from the pancreatic duct, interrupting inflammation, reducing the spasm of the sphincter of the hepatic-pancreatic ampoule (sphincter of Oddi) and limiting pancreatic secretion. Analyzing this material, we can conclude that retrograde transpapillary interventions should be performed strictly according to indications, and the number of diagnostic retrograde cholangiopancreatographies (RCPG) should be minimal. This is a major factor in the prevention of post-manipulation complications. Endoscopic stenting of the main pancreatic duct should be performed with factors that increase the risk of developing of APMP. The use of non-steroidal anti-inflammatory drugs at the preoperative stage statistically significantly reduces the risk of developing of APMP.