[Minimally invasive approach in gallstone disease complicated with acute pancreatitis]

We have evaluated the minimally invasive approaches (laparoscopy, endoscopy) in the management of the gallstone disease complicated with acute pancreatitis. Hypothesis. Emergency ERCP in gallstone pancreatitis (GSP) associated with jaundice or angiocholitis has a beneficial effect on pancreatic inflammation, eventually favoring laparoscopic cholecystectomy. We have compared 18 cases of emergency ERCP for GSP associated with jaundice or angiocholitis (Group 1) with 72 cases of GSP where ERCP was indicated on a selective basis (Group 2). Laparoscopic cholecystectomy was done after the acute bout of pancreatitis subsided. The minimally invasive approaches were completed in 89% cases in Group1 and in 90% cases in Group 2, respectively. Pancreatic morbidity was better in Group 1 (0% vs. 15.2%), but without statistical significance. General morbidity was significantly lower (0% vs. 23.6%) as well as the mean hospital stay (13 +/- 5.5 days vs. 17 +/- 10.4 days). Only the lower general morbidity and the shorter hospital stay assert the hypothesis that emergency ERCP in GSP associated with jaundice or angiocholitis has a beneficial effect on pancreatic inflammation, eventually favoring laparoscopic cholecystectomy.