A systematic review included 8 studies with a total of 557 subjects. 6 studies analysed ALT, 4 studies alkaline phosphatase, 4 studies serum bilirubin and 2 studies AST. ALT and AST were useful in diagnosing gallstone pancreatitis. The higher the serum level of ALT or AST the greater their specificity and positive predictive value in diagnosing gallstone pancreatitis, although sensitivity declines as a consequence. A three-fold elevation in ALT levels to greater than equal to 150 IU/L provides a specificity of 96%, a predictive value of 95% and a sensitivity of 48%. Serum AST had a slightly inferior predictive value. Further increases in ALT or AST levels provide limited additions to specificity and predictive values but continued decreases in sensitivity.