Role of ERCP in the management of predicted mild acute biliary pancreatitis.
OBJECTIVE
The role of endoscopic retrograde cholangiopancreatography (ERCP) in mild acute biliary pancreatitis is controversial. This study examined the results of ERCP in patients with predicted mild disease and analysed biochemical and imaging findings in relation to the occurrence of choledocholithiasis.


METHODS
There were 172 consecutive patients, admitted between January 1998 and December 2000, with the diagnosis of acute pancreatitis. All patients were investigated using transcutaneous ultrasonography and ERCP if biliary aetiology was suspected. Serum bilirubin and alkaline phosphatase were measured, together with abdominal ultrasonographic findings, as potential predictors for choledocholithiasis.


RESULTS
Biliary calculus was the aetiology in 62.8% of patients (108/172). Among these 108 patients, 79.6% (86/108) suffered from mild disease. There were only 80 patients who underwent ERCP, and the incidence of choledocholithiasis was 45% (36/80). Although significant correlation was shown between all three measured parameters (bilirubin, alkaline phosphatase and ultrasonographic abnormalities) and choledocholithiasis, their individual sensitivities, specificities and predictive values were low. Nonetheless, if all three tests were normal, the incidence of ductal stones was significantly lower than that in cases with abnormalities in any one of these parameters (4.8% vs 59.3%).


CONCLUSIONS
Routine ERCP is not recommended for patients with mild, acute biliary pancreatitis when there is no biochemical derangement or ultrasonographic evidence of a dilated biliary system.
Yeung
Yuk-Pang
YP
Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong, China. yeungyp@yahoo.com
Lo
Siu-Fai
SF
Yip
Andrew Wai-Chun
AW
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler