title: Role and timing of endoscopy in acute biliary pancreatitis.
abstract: The role and timing of endoscopy in the setting of acute biliary pancreatitis (ABP) is still being debated. Despite numerous randomized trials have been published, there is an obvious lack of consensus on the indications and timing of endoscopic retrograde cholangiopancreatography (ERCP) in ABP in meta-analyses and nationwide guidelines. The present editorial has been written to clarify the role of endoscopy in ABP. In clinical practice the decision to perform an ERCP is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography (EUS) is not currently a worldwide standard diagnostic procedure early in the course of acute biliary pancreatitis, but it has been shown to be accurate, safe and cost effective in diagnosing biliary obstructions compared with magnetic resonance cholangiopancreatography and ERCP and therefore in preventing unnecessary ERCP and its related complications. Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.
authors.affiliation: Andrea Anderloni, Alessandro Repici, Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderloni
authors.affiliation: Andrea Anderloni, Alessandro Repici, Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019160:Endosonography; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute biliary pancreatitis; Choledocolithiasis; Common bile duct stone; Endoscopic retrograde cholangiography; Endoscopic ultrasonography