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A Rational and Safe Approach to Management

John P. Neoptolemos, MA, MD, FRCS; Nicholas London, MRCP; Nicholas D. Slater, FRCS; David L. Carr-Locke, MA, MRCP; David P. Fossard, ChM, FRCS; Abdul R. Moosa, MD, FRCS

Arch Surg. 1986;121(6):697-702.

Abstract
• From a consecutive series of 112 patients with acute pancreatitis, 70 patients with suspected gallstones were randomized to urgent endoscopic retrograde cholangiopancreatography (ERCP) (<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.

(Arch Surg 1986;121:697-702)

Author Affiliations
From the Department of Surgery (Drs Neoptolemos and Moosa), University of California, San Diego; and the Departments of Surgery (Drs Neoptolemos, London, Slater, and Fossard) and Gastroenterology (Dr CarrLocke), Leicester Royal Infirmary, Leicester, England.

Footnotes
Accepted for publication March 11, 1986.

Read before the 93rd Annual Meeting of the Western Surgical Association, Rochester, Minn, Nov 20, 1985.

Reprint requests to Department of Surgery, Clinical Sciences Building, Leicester Royal Infirmary, PO Box 65, Leicester LE2 7LX, Great Britain (Dr Neoptolemos).

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