Abstract
Endoscopists who perform endoscopic retrograde cholangiopancreatography (ERCP) are frequently pressured to perform urgent (usually night or weekend) ERCP in patients with acute biliary pancreatitis in the belief that this procedure reduces morbidity and mortality. However, with the exception of those patients with concurrent acute cholangitis, data that urgent ERCP with biliary compression is helpful in all patients with acute gallstone pancreatitis are lacking. In this Practice Point commentary, I discuss the findings and limitations of a meta-analysis conducted by Petrov et al. that pooled data from three randomized, controlled trials that included 450 patients in total. Four other randomized, controlled trials on this topic were excluded from the analysis because of methodologic problems. The authors concluded that early ERCP was not associated with a significant reduction in complications or mortality in patients with predicted mild or severe acute biliary pancreatitis.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland, Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland (2005) UK guidelines for the management of acute pancreatitis. Gut 54 (suppl 3): 1–9
Forsmark CE and Baillie J (2007) AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA technical institute review on acute pancreatitis. Gastroenterology 132: 2022–2044
Petrov MS et al. (2008) Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg 247: 250–257
Baillie J (1997) Treatment of acute biliary pancreatitis. N Engl J Med 336: 286–287
Liu CL et al. (2005) Comparison of early endoscopic ultrasonography and endoscopic retrograde cholangio-pancreatography in the management of acute biliary pancreatitis: a prospective randomized study. Clin Gastroenterol Hepatol 3: 1238–1244
Ayub K et al. (2004) Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003630. 10.1002/14651858.CD003630.pub2
Fan ST et al. (1993) Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 328: 2022–2044
Acosta JM et al. (2006) Early ductal decompression versus conservative management for gallstone pancreatitis with ampullary obstruction: a prospective randomized clinical trial. Ann Surg 243: 33–40
Author information
Authors and Affiliations
Ethics declarations
Competing interests
The author declares no competing financial interests.
Rights and permissions
About this article
Cite this article
Baillie, J. Should urgent ERCP be performed in patients with acute biliary pancreatitis without acute cholangitis?. Nat Rev Gastroenterol Hepatol 5, 484–485 (2008). https://doi.org/10.1038/ncpgasthep1202
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ncpgasthep1202
