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ERCP and acute pancreatitis.

F Fiocca1, A Santagati, V Ceci

  • 1Department of General Surgery P. Stefanini, University La Sapienza, Rome, Italy.

European Review for Medical and Pharmacological Sciences
|March 1, 2003
PubMed
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Emergency Endoscopic Retrograde Cholangiopancreatography (ERCP) within 24 hours is safe and effective for acute biliary pancreatitis (ABP). Early ERCP within 72 hours showed higher complication rates and mortality compared to the 24-hour protocol.

Area of Science:

  • Gastroenterology and Hepatology
  • Interventional Endoscopy
  • Biliary Tract Diseases

Background:

  • Acute biliary pancreatitis (ABP) is a severe complication of gallstone disease, leading to significant morbidity and mortality.
  • The optimal timing for Endoscopic Retrograde Cholangiopancreatography (ERCP) in managing ABP remains a subject of ongoing clinical discussion.
  • Gallstones are a primary etiological factor in ABP, necessitating timely and effective interventions.

Purpose of the Study:

  • To evaluate and compare the safety and efficacy of an emergency ERCP protocol (within 24 hours) versus an early ERCP protocol (within 72 hours) for acute biliary pancreatitis.
  • To assess the impact of ERCP timing on complication rates and patient mortality in ABP management.
  • To determine the optimal timing for ERCP intervention in patients diagnosed with acute biliary pancreatitis.

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Main Methods:

  • A prospective study involving 45 patients diagnosed with acute biliary pancreatitis between July 1997 and July 2000.
  • Patients underwent diagnosis confirmation through clinical assessment and laboratory data, with imaging via ultrasound and CT scans.
  • All patients received ERCP with Endoscopic Sphincterotomy (ES), with interventions categorized as within 24 hours or within 72 hours post-conservative therapy.

Main Results:

  • ERCP with ES within 24 hours (22 patients) resulted in 4% complications and 4% mortality, with no significant difference in severity distribution.
  • ERCP with ES within 72 hours after conservative therapy (23 patients) showed a higher complication rate (9%) and mortality (6%), with a higher proportion of severe attacks.
  • Ultrasound revealed gallstones in 87% of patients, and CT scans indicated severe pancreatitis in the second week for all patients.

Conclusions:

  • Emergency ERCP with endoscopic sphincterotomy can be safely performed within 24 hours of acute biliary pancreatitis onset by skilled endoscopists.
  • The 24-hour ERCP protocol demonstrates a superior safety profile with lower complication and mortality rates compared to ERCP performed within 72 hours after initial conservative management.
  • This study supports the implementation of an early, within 24 hours, ERCP protocol for managing acute biliary pancreatitis to improve patient outcomes.