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Current Approach in Acute Biliary Pancreatitis - a Narrative Review
Ana-Laura Dima1, Ana-Laura Manda2, Dragos Virgil Davitoiu1,2
1"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Maedica
|April 14, 2026
Summary
Modern acute biliary pancreatitis (ABP) management focuses on physiological support and individualized care. Early diagnosis and tailored interventions improve outcomes and reduce mortality for this common condition.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Innovation
Background:
- Acute biliary pancreatitis (ABP) is the most common pancreatitis form, stemming from gallstone migration.
- Severe ABP cases still present a significant mortality risk (10-30%), despite therapeutic advancements.
Purpose of the Study:
- To review recent (2021-2025) guidelines, trials, and meta-analyses on acute biliary pancreatitis management.
- To synthesize current evidence on diagnosis, risk stratification, and therapeutic strategies for ABP.
Main Methods:
- Narrative review methodology adhering to PRISMA 2020 guidelines.
- Analysis of contemporary literature including guidelines, randomized controlled trials, and meta-analyses.
Main Results:
- Severity assessment utilizes clinical scores (BISAP, CTSI), CRP levels, and AI models (EASY-APP).
- Abdominal ultrasound is the primary diagnostic tool; MRCP and ALT aid in confirming biliary origin.
- Management emphasizes moderate fluid resuscitation (Ringer lactate), early enteral nutrition, and selective ERCP. Early cholecystectomy is standard for mild ABP, with step-up approaches for severe cases.
Conclusions:
- Current ABP management trends towards physiological, individualized, and minimally invasive strategies.
- Tailored supportive and interventional care in specialized centers improves outcomes and reduces mortality.
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