ERCP in acute pancreatitis.
BACKGROUND
The role of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis has evolved over years since its introduction in 1968. Its importance in diagnosing the etiology of pancreatitis has steadily declined with the advent of less invasive diagnostic tools. The therapeutic implications of ERCP in acute pancreatitis are many fold and are directed towards management of known etiological factors or its related complications. This article highlights the current status of ERCP in acute pancreatitis.


METHODS
An English literature search using PubMed database was conducted on ERCP in acute pancreatitis, the etiologies and complications of pancreatitis amenable to endotherapy and other related subjects, which were reviewed.


RESULTS
ERCP serves as a primary therapeutic modality for management of biliary pancreatitis in specific situations, pancreatitis due to microlithiasis, specific types of sphincter of Oddi dysfunction, pancreas divisum, ascariasis and malignancy. In recurrent acute pancreatitis and smoldering pancreatitis it has a definite therapeutic utility. Complications of acute pancreatitis including pancreatic-duct disruptions or leaks, benign pancreatic-fluid collections and pancreatic necrosis can be beneficially dealt with. Intraductal ultrasound and pancreatoscopy during ERCP are useful in detecting pancreatic malignancy.


CONCLUSIONS
The role of ERCP in acute pancreatitis is predominantly therapeutic and occasionally diagnostic. Its role in the management continues to evolve and advanced invasive procedures should be undertaken only in centers dedicated to pancreatic care.
Cherian
Jijo V
JV
Department of Gastroenterology, Stanley Medical College & Hospital, Chennai, India. drjijovc@yahoo.co.in
Selvaraj
Joye Varghese
JV
Natrayan
Rajesh
R
Venkataraman
Jayanthi
J
D000208:Acute Disease; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006801:Humans; D010179:Pancreas / Q000002:abnormalities; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000000981:diagnostic imaging*; D046628:Sphincter of Oddi Dysfunction / Q000000981:diagnostic imaging