Biliary pancreatitis: a review. Emphasizing appropriate endoscopic intervention.

Area of Science:

• Gastroenterology
• Hepatology
• Surgical Gastroenterology

Background:

• Gallstones are a frequent etiology of acute pancreatitis.
• Acute biliary pancreatitis necessitates a comprehensive understanding of its natural history and pathogenesis.

Purpose of the Study:

• To review acute biliary pancreatitis, covering its natural history, pathogenesis, diagnosis, severity assessment, and management.
• To highlight the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in managing biliary pancreatitis.

Main Methods:

• Review of natural history, pathogenesis, diagnosis, and severity assessment of acute biliary pancreatitis.
• Detailed examination of management strategies, including surgical history and endoscopic interventions.
• Analysis of four prospective randomized clinical trials to guide early endoscopic therapy decisions.

Main Results:

• Transient obstruction is the primary pathogenetic event in acute biliary pancreatitis.
• Early prognostic signs, organ failure, and local complications are crucial for severity assessment.
• ERCP and endoscopic sphincterotomy play a significant role in managing specific patient groups.

Conclusions:

• A structured endoscopic approach, incorporating severity stratification and intervention principles, is proposed for acute biliary pancreatitis.
• Management strategies should consider sterile and infected pancreatic necrosis.
• ERCP and endoscopic sphincterotomy are vital tools in the evolving management of biliary pancreatitis.