A prospective study of ERCP and endoscopic sphincterotomy in the diagnosis and treatment of gallstone acute pancreatitis. A rational and safe approach to management
J. P. Neoptolemos, N. London, N. D. Slater, D. L. Carr-Locke, D. P. Fossard and A. R. Moosa
From a consecutive series of 112 patients with acute pancreatitis, 70
patients with suspected gallstones were randomized to urgent endoscopic
retrograde cholangiopancreatography (ERCP) (less than 72 hours) and
endoscopic sphincterotomy (ES) if choledochal stones were present (n = 35),
or to conventional treatment (n = 35). Endoscopic retrograde
cholangiopancreatography, successful in 89% of cases, indicated choledochal
stones in 11 patients, all of whom underwent successful stone retrieval by
ES. Later during hospital admission, ERCP was performed in 13 more patients
and choledochal calculi were extracted from two patients by ES. No
complications were attributable to ERCP or ES. Two patients died of biliary
pancreatitis; both had been conventionally treated and may have benefited
from urgent ERCP/ES. Our experience, which extends to another 24 patients
with ERCP and ten with ES during acute pancreatitis, indicates that these
are safe techniques and deserve wider consideration in the management of
acute pancreatitis.
