Current Approach in Acute Biliary Pancreatitis - a Narrative Review

Acute biliary pancreatitis (ABP), caused by gallstone migration, is the most common form of acute pancreatitis. Although overall mortality has decreased due to therapeutic advances, severe forms still carry a mortality rate of 10-30%.

This narrative review analyses guidelines, randomized trials and meta-analyses published between 2021-2025 that were selected according to PRISMA 2020 criteria.

Severity assessment relies on clinical scores (BISAP, CTSI) and 48-hour CRP levels, while artificial intelligence models such as EASY-APP may improve early risk stratification. Abdominal ultrasound remains the first-line diagnostic tool, with MRCP and elevated ALT supporting biliary aetiology. Current management favours moderate fluid resuscitation with Ringer lactate and early enteral nutrition, while avoiding total parenteral nutrition. Pain control may include NSAIDs or opioids, with epidural analgesia considered in severe cases. Antibiotic therapy is reserved for infected necrosis or cholangitis. Endoscopic retrograde cholecysto-pancreatography (ERCP) is selectively indicated mainly for therapeutic purposes. Early cholecystectomy during the same admission is the standard for mild ABP, whereas moderate and severe forms require a step-up approach.

Modern management of ABP is oriented to more physiological approaches, emphasizes individualized care, minimally invasive strategies and physiological support, as well as a tailored approach to the support and interventional components, contributing to improved outcomes and reduced mortality in specialized centres.