Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography.
BACKGROUND
Acute biliary pancreatitis, particularly severe pancreatitis, necessitates urgent diagnosis and treatment of common bile duct (CBD) stones. The roles of urgent endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary pancreatitis were prospectively studied.


METHODS
Thirty-five consecutive patients with suspected acute biliary pancreatitis underwent urgent ultrasonography, computed tomography (CT), EUS, and ERCP. Endoscopic sphincterotomy (ES) was performed for CBD stones. We investigated (1) imaging diagnostic results of CBD stones and intrapancreatic and extrapancreatic pathology and (2) the outcome of ERCP.


RESULTS
Imaging studies established a biliary origin in 24 patients, 15 with and 9 without CBD stones. According to Acute Physiology and Chronic Health Evaluation II scores, 6 had severe and 18 had mild pancreatitis. EUS (100%) and ERCP (100%) were significantly more sensitive for CBD stones than were ultrasonography (47%) and CT (47%). EUS detected pancreatic necrosis (100%), as well as inflammation in the lesser sac (100%) and retroperitoneum (81%), which CT confirmed. No complications related to ERCP occurred. After ES, rates of morbidity and mortality related to pancreatitis were 8% and 0%, respectively.


CONCLUSIONS
EUS, an accurate and minimally invasive modality, may limit ERCP to therapeutic use in biliary pancreatitis. EUS is recommended if ultrasonography and CT have failed to detect CBD stones. CBD stones should be treated with urgent ES.
Sugiyama
M
M
First Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan.
Atomi
Y
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000592:standards; D019160:Endosonography / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D042882:Gallstones / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed