[Endoscopy in the diagnosis and treatment of acute obstructive pancreatitis]

Opie's theory that obstruction of the Ampulla of Vateri can be a significant factor in acute pancreatitis, is supported by various clinical observations. The significance of further pathogenetic factors such as anatomic variance of the duct systems, pressure differences, direction of flow and composition of secretions will have to be established in future studies. The ERCP plays an important role as a safe and sensitive diagnostic procedure. Therefore, ERC should be carried out in all suspected acute obstructive pancreatitis cases. The appropriate selection of patients employing clinical and laboratory criteria and other imaging procedures should, in the future, be defined more accurately. Presently, in proven ampullary obstruction we always perform immediate endoscopic therapy. However, the gallstone-induced obstructive pancreatitis usually has a good recovery course, even with conservative management. Therefore, clinical studies should prospectively direct us to those cases, in which the invasive endoscopic procedure should be limited, i.e. patients with expected serious courses. Diagnostic and therapeutic endoscopy does not increase the morbidity and mortality of the acute obstructive pancreatitis. Unlike the surgical approach, the endoscopic procedure is less invasive and is preferred by patients.