Normal pancreatic ageing is characterized by functional and morphological changes of the pancreatic parenchyma and of the ductal system, which, however, do not interfere with normal exocrine pancreatic function. It can be speculated that 'pancreatic lithiasis in the aged' as well as the 'senile idiopathic chronic pancreatitis', two conditions of chronic pancreatitis in the elderly, may represent more extreme forms of these normal age-related changes in pancreatic structure and function. In elderly people, acute and chronic pancreatitis are only rarely related to alcohol abuse, in contrast to the situation in a younger patient population. The presence of gallstones represents the most frequent cause of acute pancreatitis in the elderly. In most aged patients with acute biliary pancreatitis, endoscopic sphincterotomy is the treatment of choice, even when bile duct stones cannot clearly be demonstrated at ERCP. Endoscopic sphincterotomy has been shown to reduce morbidity as well as mortality rates in acute biliary pancreatitis. This technique can even be considered as treatment of choice in elderly patients with an increased operative risk. An elective laparoscopic cholecystectomy should be performed in elderly patients with an acceptable operative risk.