To evaluate whether a low-osmolar contrast medium could decrease hyperamylasemia after endoscopic retrograde pancreatography, a prospective randomized double-blind trial of 54 consecutive patients with suspected pancreatic disease referred for endoscopic retrograde pancreatography was performed. The low-osmolar contrast medium iohexol and high-osmolar amidotrizoate were used. No statistically significant differences with regard to rise in pancreatic-type amylase, pain reaction, or diagnostic information were found. No case of acute pancreatitis was observed.