Beneficial effects of ERCP and papillotomy in predicted severe biliary pancreatitis.
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.
Besselink
M G H
MG
Department of Surgery, University Medical Center Utrecht, The Netherlands.
van Minnen
L P
LP
van Erpecum
K J
KJ
Bosscha
K
K
Gooszen
H G
HG
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