title: Beneficial effects of ERCP and papillotomy in predicted severe biliary pancreatitis.
abstract: OBJECTIVE
  Extensive circumstantial evidence indicates that patients with a predicted severe attack of acute biliary pancreatitis (ABP) should undergo an endoscopic retrograde cholangiography with papillotomy (ERC/PT). However, in clinical practice this procedure is not always performed. This study was conducted to compare outcome in patients with and without ERC/PT.
  
  
  METHODS
  Thirty-five of 80 patients admitted with ABP had a predicted severe attack (three or more Ranson criteria). Only in 24 of these 35 patients was an ERC/PT performed.
  
  
  RESULTS
  In the ERC/PT group, significantly less pancreatic necrosis (8 vs. 64%, p<0.001) occurred, hospital stay was shorter (median 22 +/- 5 vs. 51 +/- 19 days, P=0.08) and mortality was lower (8 vs. 36%, P=0.01). Twenty-three patients (66%) underwent cholecystectomy after a median period of 10 weeks (range 0-26 weeks) after discharge. During the waiting period, in the ERC/PT group, two patients developed acute cholecystitis whereas recurrent ABP and common bile duct stones occurred in one patient each.
  
  
  CONCLUSIONS
  In patients with a predicted severe attack of ABP, performing ERC/PT is associated with less morbidity and lower mortality.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: M G H
authors.initials: MG
authors.lastname: Besselink
authors.forename: L P
authors.initials: LP
authors.lastname: van Minnen
authors.forename: K J
authors.initials: KJ
authors.lastname: van Erpecum
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic; D015996:Survival Rate; D016896:Treatment Outcome