Background/Aims: There are scant data on outcomes for ERCP induced severe acute pancreatitis (ESAP). In large series of acute pancreatitis (AP) patients ERCP- induced pancreatitis has been reported to have higher morbidity and mortality compared to other forms of AP. We compared clinical outcomes of ESAP with those of other forms of severe acute pancreatitis (SAP). Methods: Sixteen patients with ESAP and 196 patients with SAP due to other causes were admitted to Mayo Clinic Hospitals between 1992 and 2001. Medical records were reviewed to compare their length of stay, ICU stay, morbidity (incidence of organ failure, sepsis, or local complications including pancreatic and peri-pancreatic necrosis, pseudocysts, abscess, infection and need for surgery) and mortality. Results: Of the 16 patients with ESAP, 13 had undergone therapeutic and 3 had diagnostic ERCP. On comparison of ESAP with other forms of SAP, the median length of hospital stay (24 vs 30 days), need for ICU care (50% vs 66%), and median length of ICU stay (1 vs 4 days) were similar. The incidence of organ failure (33% vs 54%), sepsis (31% vs 36%) and DIC (6% in both groups) were also similar in the two groups. Incidence of pancreatic necrosis (19% vs 29%), pseudocyst (31% vs 44%), and abscess (13% vs 26%) was not different in the two groups. Infection (+ve blood or pancreatic fluid culture) occurred in 8/16 ESAP patients compared to 68/196 with other forms of SAP (p=ns). Candida albicans infection occurred in 1/8 ESAP versus 18/68 with other forms of SAP (p=ns). Surgery was performed in 63% of ESAP vs 67% of SAP due to other causes. Mortality was similar in the two groups (25% vs 16%). Conclusions: The morbidity and mortality of ERCP-induced SAP are similar to those of SAP due to other causes.