40 patients with the acute necrotic pancreatitis and verified biliary hypertension were included in the study. During the endoscopic retrograde cholangiopancreaticography we avoided the main pancreatic duct contrast enhancement. The canulation during papillosphincterotomy (PST) was not used if the concrement was infringed in the ampulla. The use of these methods led to fast relief of the biliary hypertension and truthworthy positive dynamics of the disease course. The negative consequences were usually limited to transitory amilasemia and the pancreonecrosis progression was registered in only 4±4% cases. In comparison with cholecystostomy, the ERCP with PST showed better prognosis considering the frequency of septic complications and terms of hospital stay. The statistical analysis proved the the ERCP with PST are preferable to cholecystostomy in cases of pancreonecrosis with choledochlithiasis and biliary hypertension and the overall severity of pancreonecrosis is not higher than 11 by the physiological condition scale.