Objective To explore the effects of endoscopic retrograde cholangiopancreatography (ERCP) on serum amylase (AMS) level and intestinal function recovery in patients with acute biliary pancreatitis (ABP) complicated with cholangitis. Methods A total of 110 patients with acute biliary pancreatitis complicated with cholangitis who were treated in our hospital were selected between January 2016 and January 2021. Patients with ABP and cholangitis underwent emergency ERCP within 24 h, and patients who were unable to tolerate or refuse ERCP performed conservative treatment. According to the treatment methods, the patients were divided into conservative treatment group and ERCP group. Conservative treatment group received routine conservative treatment, and ERCP group was given ERCP. The changes in levels of AMS and serum lipase (LPS)，liver functionrelated indicators and inflammatory factors, gastrointestinal function recovery time and clinical symptom improvement time were compared between the two groups before and after treatment. Results The levels of AMS and LPS of the two groups of patients were decreased on the 5th d of treatment, and the levels of AMS and LPS of patients in ERCP group on the 5th d of treatment were lower than those in conservative treatment group (P<005). The levels of alanine aminotransferase (ALT)，aspartate aminotransferase (AST)，glutamyl transpeptidase (GGT) and total bilirubin (TBIL) on the 5th d of treatment were reduced in the two groups of patients, and the above liver function indicators in ERCP group were lower than those in conservative treatment group on the 5th d of treatment (P<0.05). On the 5th d of treatment, the levels of interleukin6 (IL6)，interleukin8 (IL8)，Creactive protein (CRP) and tumor necrosis factorα (TNFα) were decreased in the two groups of patients, and the levels of above inflammatory factors in ERCP group on the 5th d of treatment were lower than those in conservative treatment group (P<0.05). After treatment, the anal exhaust recovery time, first spontaneous defecation time and time of starting eating in ERCP group after treatment were shorter than those in conservative treatment group (P<0.05). After treatment, the abdominal pain relief time, normal body temperature recovery time, disappearance time of nausea and vomiting and hospital stay of patients in ERCP group were shorter than those in conservative treatment group (P<005).Conclusion ERCP can reduce the levels of AMS and LPS, relieve the liver function injury, reduce inflammatory response, speed up the recovery of gastrointestinal function, effectively improve the clinical symptoms and shorten the hospital stay.