The specific management and outcome of acute biliary pancreatitis in elderly patients is not well established. The aim of this study was to assess the outcome of elderly compared to younger patients after acute biliary pancreatitis. Retrospective analysis of consecutive patients admitted with acute biliary pancreatitis between January 2006 and December 2012. Elderly patients (≥ 70 years) were compared to younger patients (< 70 years) in a case-control study. Comorbidities were assessed according to the Charlson score. Clinical (Atlanta score) and radiological (Balthazar and computed tomography severity index scores) severity were analyzed, as well as clinical outcome. Among 212 patients admitted with acute biliary pancreatitis, 76 were > 70 years (35.8%). Elderly patients had a higher Charlson comorbidity index score at admission (p < 0.001). No difference was observed in terms of clinical and radiological severity of acute pancreatitis. The median hospital stay was longer in elderly (11 days, interquartile range 7-15) than in younger patients (7 days, interquartile range 5-11) (p < 0.001). No difference was observed regarding in-hospital 90-day mortality (3 vs. 1 patients, p = 0.133). Elderly patients had similar clinical and radiological severity of acute biliary pancreatitis compared to younger patients.