Should urgent ERCP be performed in patients with acute biliary pancreatitis without acute cholangitis?

Endoscopists who perform endoscopic retrograde cholangiopancreatography (ERCP) are frequently pressured to perform urgent (usually night or weekend) ERCP in patients with acute biliary pancreatitis in the belief that this procedure reduces morbidity and mortality. However, with the exception of those patients with concurrent acute cholangitis, data that urgent ERCP with biliary compression is helpful in all patients with acute gallstone pancreatitis are lacking. In this Practice Point commentary, I discuss the findings and limitations of a meta-analysis conducted by Petrov et al. that pooled data from three randomized, controlled trials that included 450 patients in total. Four other randomized, controlled trials on this topic were excluded from the analysis because of methodologic problems. The authors concluded that early ERCP was not associated with a significant reduction in complications or mortality in patients with predicted mild or severe acute biliary pancreatitis.