In a prospective study, consecutive patients admitted to one of the surgical units at Riyadh Central Hospital with a diagnosis of acute biliary pancreatitis (ABP) underwent, after stabilization, urgent ERCP within 72 hours of admission. A total of 64 patients (35 males, 29 females) were treated over a four-year period (1986)(1987)(1988)(1989)(1990). Fortyeight patients were found to have common bile duct stones when endoscopic sphincterotomy (ES) and stone extraction was performed, including four patients with concomitant cholangitis. This was followed by a significant decrease in mean values of the biochemical parameters: serum amylase, SGOT, total bilirubin (P < 0.001) and alkaline phosphatase (P < 0.02), with a corresponding clinical improvement. Urgent ERCP+ES was not associated with any serious complications. There was no hospital mortality in this series. Details of the endoscopic findings and treatment are summarized. Based on the present study and others cited, the role of ERCP in the diagnosis and management of ABP are discussed and recommendations suggested.

We apologize for not referring to their report of CHF in Saudi children. 2 This was an inadvertent event as two Medline searches on the subject while preparing for writing our paper did not come up with any reports from Saudi Arabia. We are grateful for their letter as we now realize the searches we did were not entirely reliable, since the journal with Dr. Abdullah et al. paper is indexed.However, we still believe that our report is valid as it reports on CHF presenting in early adulthood as in the case of our index patient and one of hi s sisters; the second sister is also an old child, age 12. Those two sisters were not further investigated for the presence of esophageal varices as they were completely asymptomatic and were normal on physical examination and laboratory testing. They are however, still attending follow-up clinics.The other aim of our report is to stress the importance and ease of family screening by noninvasive and readily available investigation, i.e. ultrasonography.We do again apologize to Dr. Abdulla et al. for the unintentional omission of their excellent report of CHF among Saudi children that would have complemented our report of the condition in adults.