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Acute pancreatitis--ERCP/endoscopic papillotomy (EPT) yes or no?
1Gastrointestinal Unit, University Hospital Inselspital DMLL, Berne.
Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
|November 15, 2000
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) with or without endoscopic papillary balloon dilation (EPBD) offers no benefit for mild biliary pancreatitis. However, for severe cases, ERCP with EPBD can reduce complications and mortality.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic procedures
Background:
- Historically, ERCP and EPBD were contraindicated in acute pancreatitis.
- Recent studies have challenged this view, comparing endoscopic treatment with conservative management.
Purpose of the Study:
- To evaluate the efficacy of ERCP and EPBD in managing acute pancreatitis based on recent evidence.
- To determine the role of ERCP and EPBD in different severities and etiologies of pancreatitis.
Main Methods:
- Analysis of four prospective randomized studies comparing ERCP +/- EPBD with conservative treatment.
- Review of outcomes in mild vs. severe biliary pancreatitis, specific pancreatitis types, and special patient populations.
Main Results:
- No advantage of ERCP +/- EPBD over conservative treatment in mild biliary pancreatitis.
- In severe biliary pancreatitis, ERCP with EPBD reduced purulent cholangitis, morbidity, and mortality.
- ERCP + EPBD showed effectiveness in specific conditions like deteriorating mild pancreatitis, smoldering pancreatitis, persistent cholostasis, gallstone pancreatitis in non-surgical candidates, and pancreatitis due to sludge/microlithiasis.
Conclusions:
- ERCP with EPBD is beneficial in severe biliary pancreatitis and selected cases of mild or recurrent pancreatitis.
- Conservative treatment remains the primary approach for alcoholic, metabolic, and infectious pancreatitis.
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