[TRANSPAPILLARY INTERVENTIONS FOR AN ACUTE PANCREATITIS]

Area of Science:

• Gastroenterology
• Surgical Endoscopy
• Hepatobiliary Surgery

Background:

• Acute pancreatitis (AP) is a common gastrointestinal emergency.
• Biliary causes are a frequent etiology of AP, necessitating prompt diagnosis and management.
• Endoscopic retrograde pancreatocholangiography (ERCP) is a key diagnostic and therapeutic tool.

Purpose of the Study:

• To evaluate the efficacy and diagnostic yield of emergency ERCP in patients with suspected biliary AP.
• To determine the proportion of patients with confirmed biliary AP requiring intervention.
• To assess outcomes in patients with non-biliary AP.

Main Methods:

• Retrospective analysis of 513 patients admitted with suspected biliary AP.
• Emergency ERCP performed within 4-6 hours of hospital admission.
• Diagnostic confirmation, identification of etiology (calculous cholecystitis, choledocholithiasis, residual choledocholithiasis), and therapeutic interventions.

Main Results:

• ERCP confirmed biliary AP in 451 (87.9%) patients.
• Cholelithiasis with choledocholithiasis was the most common cause (89.1% of confirmed cases).
• Residual choledocholithiasis was found in 10.9% of confirmed cases. Biliary causes were excluded in 62 (12.1%) patients.

Conclusions:

• Emergency ERCP is highly effective in diagnosing biliary AP and guiding timely intervention.
• Endoscopic papillosphincterotomy and choledocholith extraction are standard treatments for biliary AP.
• Conservative management is appropriate for AP of non-biliary origin, with specific findings in duodenum or pancreatic ducts noted.