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[Endoscopic sphincterotomy in acute biliary pancreatitis. A multicenter study].
A Gargiulo1, F Barbaro, G B Valentini
1I Divisione Chirurgica, Ospedale S. Pertini, Roma.
Minerva Chirurgica
|April 22, 1999
Summary
Early endoscopic sphincterotomy in biliary pancreatitis significantly reduces complications and mortality. This minimally invasive procedure, performed within 48 hours, lowers surgical intervention rates and improves patient outcomes, offering a safer alternative to traditional treatments.
Area of Science:
- Gastroenterology
- Minimally Invasive Procedures
- Biliary Tract Diseases
Background:
- Severe acute pancreatitis carries a high mortality rate (around 30%).
- Biliary hypertension and infection are recognized as primary causes of biliary pancreatitis.
- Advancements in diagnostics and disease management have improved control over pancreatitis progression.
Purpose of the Study:
- To evaluate the efficacy of early endoscopic sphincterotomy in preventing severe pancreatitis.
- To assess the impact of endoscopic sphincterotomy on reducing necrosis and organ failure.
- To compare outcomes of early endoscopic intervention versus traditional surgical approaches.
Main Methods:
- A multicentric trial involving 114 hospitals and over 10,000 pancreatitis cases.
- Endoscopic sphincterotomy performed in 55% of diagnosed biliary pancreatitis cases.
- Intervention timing assessed within 48 hours of symptom onset for Balthazar grades 2-3.
Main Results:
- Endoscopic sphincterotomy was successfully performed within 48 hours in 86% of indicated patients.
- Procedure-related complications were reported in less than 4% of cases.
- Significant reduction in the need for surgical operations (6.7%).
Conclusions:
- Early endoscopic sphincterotomy effectively prevents progression to necrosis and sepsis.
- The procedure led to a substantial decrease in overall mortality to 2.5%.
- Endoscopic sphincterotomy represents a safe and effective alternative to surgery for biliary pancreatitis.