The role of endoscopic retrograde cholangiopancreatography in management of patients recovering from acute biliary pancreatitis in the laparoscopic era.
BACKGROUND
Traditionally an episode of acute biliary pancreatitis (ABP) is an indication for direct imaging of the biliary tree. The optimal approach may vary according to local expertise, and endoscopic retrograde cholangiopancreatography (ERCP) is the most common. The fact that the incidence of choledocholithiasis in patients recovering from ABP varies between 3 and 33% raises a question about the necessity of visualizing the biliary tree in all patients recovering from ABP.


METHODS
In order to evaluate this policy, we reviewed 48 ERCPs performed on patients recovering from ABP who were scheduled for laparoscopic cholecystectomy (LC). We checked the correlations between ERCP findings and the severity of pancreatitis, biochemistry values (which were sampled during the acute phase), and ultrasonographic (US) findings.


RESULTS
The ERCP demonstrated common bile duct (CBD) stones in 11 (22.9%) patients. US finding of a dilated CBD and maximal aspartate transaminase (AST) values higher than 90 units/l were significantly correlated with CBD stones (a relative risk [RR] of 2.95 with a 95% confidence interval [CI] for a dilated CBD and RR of 3.89 with a 95% CI of 1.18-12.80 for an AST value higher than 90 units/l). No other parameters were significantly correlated with CBD stones.


CONCLUSIONS
We, therefore, recommend performing a preoperative ERCP only on patients who present with an ultrasonographic finding of CBD dilatation. The correlation to high AST is still to be proven.
Lin
G
G
Department of Surgery "B", Assaf Harofeh Medical Center, Zerifin 70300, Tel Aviv University, Israel.
Halevy
A
A
Girtler
O
O
Gold-Deutch
R
R
Zisman
A
A
Scapa
E
E
D000208:Acute Disease; D001219:Aspartate Aminotransferases / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct / Q000000981:diagnostic imaging; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D011300:Preoperative Care; D014463:Ultrasonography
D001219:Aspartate Aminotransferases