Early Treatment of Acute Biliary Pancreatitis by Endoscopic Papillotomy

Fan, Sheung‐Tat; Lai, Edward C. S.; Mok, F. P. T.; Lo, Chung‐Mau; Zheng, Shusen; Wong, John

doi:10.1056/nejm199301283280402

Cited by 725 publications

(347 citation statements)

References 18 publications

Supporting

Mentioning

314

Contrasting

Unclassified

Order By: Relevance

“…These studies have compared early ERCP with biliary sphincterotomy with delayed or selective ERCP (240)(241)(242). Inclusion criteria and presence of bile duct stones vary considerably among these trials.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

“…One interpretation is that there is a strong correlation between persistent biliary obstruction and more severe disease (245). Hence, common bile duct stones were seen more often in the two positive studies (240,242) than in the negative study (241). Retained common bile duct stones could lead to organ failure by causing ascending cholangitis or by causing intensification of the pancreatitis if a gallstone is blocking the pancreatic duct.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

See 1 more Smart Citation

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

View full text Add to dashboard Cite

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

View full text Add to dashboard Cite

“…Evaluation of the CBD for a planned cholecystectomy to decide on CBD exploration should be scheduled with a tight interval because the prevalence of CBD stones may change in time. In fact, multiple studies have shown that the prevalence of CBD stones in relation to admission time decreases because of spontaneous stone migration [33][34][35][36][37] (Table 2). Conversely, when a CBD is found to be free of stones at admission, this might be not representative for the time of surgery because migration of gallbladder stones into the CBD may have occurred just before the operation.…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

et al. 2009

View full text Add to dashboard Cite

Background Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks.Conclusion From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.Keywords Acute biliary pancreatitis Á Cholecystectomy Á Endoscopic sphincterotomy Á ERCP Á Recurrent Acute biliary or gallstone pancreatitis (ABP) is an inflammatory condition of the pancreas induced by gallstones [1]. The initial treatment of ABP can be either conservative or interventional. The coexistence of cholangitis is an accepted indication for the performance of endoscopic retrograde cholangiopancreaticography (ERCP). However, whether this procedure is performed for patients with ABP depends on local expertise and guidelines, as is the decision to perform an endoscopic sphincterotomy (ES) [2][3][4][5].After patients have recovered from their first attack of ABP, most guidelines advocate a cholecystectomy to prevent a recurrent attack or other gallstone-related disorders such as symptomatic choledocholithiasis, cholecystitis, gallstone ileus, jaundice, and cholangitis [2][3][4][5]. ''Recurrent'' symptomatic choledocholithiasis after an initial attack of ABP may be preexisting common bile duct (CBD) stones not detected at the time of the primo episode or stones that migrated from the gallbladder into the CBD after initial stone clearance. Choledocholithiasis also may have developed newly within the bile duct after cholecystectomy.

show abstract

“…In the 1990s, urgent ERCP (within 24 hours after admission) was recommended by the authors of a randomized controlled trial, who found good outcomes in the ERCP group. 23 However, a recent meta-analysis revealed that early ERCP (within 72 hours after admission) in patients with acute gallstone pancreatitis did not improve mortality or either local or systemic complications of pancreatitis, regardless of the severity. 24,25 On the other hand, another study reported that early ERCP reduced pancreatitis-related complications in severe pancreatitis but had no advantage for the patients with mild pancreatitis.…”

Section: Discussionmentioning

confidence: 98%

The Usefulness of Early Endoscopic Ultrasonography in Acute Biliary Pancreatitis with Undetectable Choledocholithiasis on Multidetector Computed Tomography

Park

Kim

Han

et al. 2016

Korean J Gastroenterol

View full text Add to dashboard Cite

Background/Aims: EUS can detect bile duct stones (BDS) that are undetectable on multidetector computed tomography (MDCT). BDS associated with acute biliary pancreatitis (ABP) are small and tend to be excreted spontaneously. This study evaluated the usefulness of early EUS in patients with ABP and undetectable BDS on MDCT. Methods: Forty-one patients with ABP and undetectable BDS on MDCT underwent EUS within 24 hours of admission and were diagnosed with BDS, sludge, dilated common bile duct (CBD), or normal CBD. ERCP was performed in patients with BDS, sludge, or clinical deterioration. The diagnostic yield and the effects of early EUS on morbidity, mortality, and the length of hospitalization were evaluated. Results: EUS detected BDS or sludge in 48.8% of patients examined. BDS was the diagnosis in 13 patients, sludge in seven, and neither for 21 patients. ERCP was performed in 20 patients with BDS or sludge, in two patients with coexisting cholangitis, and in one patient with worsening liver function tests. ERCP identified BDS in 12 patients and sludge in seven. No lesions were diagnosed in four patients by ERCP. All patients improved, and the length of hospitalization in patients with ERCP was 9.0 days, without ERCP 7.1 days. Two patients with major complications by ERCP were hospitalized for a prolonged time. Conclusions: Early EUS may be useful to select patients for therapeutic ERCP in cases of suspected ABP with undetectable BDS on MDCT. (Korean J Gastroenterol 2016;68:202-209)

show abstract

Early Treatment of Acute Biliary Pancreatitis by Endoscopic Papillotomy

Abstract: Emergency ERCP with or without endoscopic papillotomy is indicated in the treatment of patients with acute pancreatitis.

Cited by 725 publications

References 18 publications

Practice Guidelines in Acute Pancreatitis

Practice Guidelines in Acute Pancreatitis

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

The Usefulness of Early Endoscopic Ultrasonography in Acute Biliary Pancreatitis with Undetectable Choledocholithiasis on Multidetector Computed Tomography

Contact Info

Product

Resources

About