[Acute biliary pancreatitis. Therapeutic trends]

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary System Disorders

Background:

• Biliary pancreatitis management traditionally involves cholecystectomy and common bile duct clearance.
• Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) were historically contraindicated for acute biliary pancreatitis.
• The optimal timing for definitive biliary surgery and the role of ERCP remain subjects of ongoing discussion.

Purpose of the Study:

• To evaluate the efficacy and outcomes of early ERCP and LC in patients with acute biliary pancreatitis.
• To compare the results of early versus delayed ERCP in managing biliary pancreatitis.
• To assess the safety and success rates of laparoscopic cholecystectomy in conjunction with ERCP.

Main Methods:

• A two-year study included 51 patients diagnosed with acute biliary pancreatitis.
• Seven patients (14%) required emergency laparotomy due to severe conditions and necrosis.
• Elective open cholecystectomy and common bile duct exploration were performed in 7 patients post-resolution.

Main Results:

• Early ERCP followed by LC demonstrated favorable outcomes.
• 33 patients underwent preoperative ERCP, with 17 receiving it within 72 hours of admission.
• Laparoscopic cholecystectomy was successful in 27 of 29 patients, with a low complication rate.

Conclusions:

• ERCP and sphincterotomy, combined with LC, play a significant role in managing acute biliary pancreatitis.
• This combined approach is particularly beneficial in centers with advanced endoscopic capabilities.
• Implementing this strategy can potentially decrease the incidence of cholangitis and recurrent pancreatitis.