title: Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study.
abstract: BACKGROUND
  The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients.
  
  
  METHODS
  We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 mumol/L] and/or dilated common bile duct) were analyzed separately.
  
  
  RESULTS
  Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P= 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734).
  
  
  CONCLUSIONS
  Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present.
authors: Department of Surgery, University Medical Center Utrecht, Utrecht 3508 GA, The Netherlands.
authors: Hjalmar C
authors: HC
authors: van Santvoort
authors: Marc G
authors: MG
authors: Besselink
authors: Annemarie C
authors: AC
authors: de Vries
authors: Marja A
authors: MA
authors: Boermeester
authors: Kathelijn
authors: K
authors: Fischer
authors: Thomas L
authors: TL
authors: Bollen
authors: Geert A
authors: GA
authors: Cirkel
authors: Alexander F
authors: AF
authors: Schaapherder
authors: Vincent B
authors: VB
authors: Nieuwenhuijs
authors: Harry
authors: H
authors: van Goor
authors: Cees H
authors: CH
authors: Dejong
authors: Casper H
authors: CH
authors: van Eijck
authors: Ben J
authors: BJ
authors: Witteman
authors: Bas L
authors: BL
authors: Weusten
authors: Cees J
authors: CJ
authors: van Laarhoven
authors: Peter J
authors: PJ
authors: Wahab
authors: Adriaan C
authors: AC
authors: Tan
authors: Matthijs P
authors: MP
authors: Schwartz
authors: Erwin
authors: E
authors: van der Harst
authors: Miguel A
authors: MA
authors: Cuesta
authors: Peter D
authors: PD
authors: Siersema
authors: Hein G
authors: HG
authors: Gooszen
authors: Karel J
authors: KJ
authors: van Erpecum
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000150:complications*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications; D011446:Prospective Studies