[Biliary pancreatitis--diagnostic and therapeutic possibilities with ERCP and endoscopic papillotomy]

The present retrospective study was undertaken to investigate the value of diagnostic procedures--clinical and biochemical parameters, ultra-sonography and ERCP--and the influence of endoscopic papillotomy on the course of biliary pancreatitis in 22 patients. A further 22 patients with alcoholic pancreatitis served as a control group. In the 22 patients with biliary pancreatitis, the case history pointed to biliary disease in 14 cases; in contrast to the patients with alcoholic pancreatitis, in none of these patients did excessive alcohol consumption precede the disease. Seven out of the 22 patients with biliary pancreatitis, but only 2 out of the 22 cases of alcoholic pancreatitis had a previous cholecystectomy. The pain was localized in the right upper abdomen in 60% of the biliary pancreatitis patients, as compared with only 32% of the patients with alcoholic pancreatitis. The laboratory parameters (serum amylases, SGOT, serum bilirubin and leucocytes) did not permit any differentiation between biliary and alcoholic pancreatitis. With respect to the biliary genesis of pancreatitis, the sensitivity of the ultrasound examination was about 68%. The endoscopic detection of a so-called "stone papilla", spontaneous suprapapillary bilio-duodenal fistula, or a blood-tinged papilla, was evidence in favour of a biliary cause of the pancreatitis. In 12 patients, the stones has passed spontaneously; 10 patients were submitted to endoscopic papillotomy for bile duct stones detected by ERCP, and the stones were removed in 9/10 patients. A worsening of the clinical picture by ERCP was not observed in any of the patients. The course of serum amylases, leucocytes and pain in the papillotomied patients corresponded to that in patients with spontaneous stone passage. The results of the present study show that endoscopic papillotomy with stone extraction represents, in most patients with biliary pancreatitis, a possibility for causal therapy, avoiding an emergency surgical intervention. In demonstrated cholecystolithiasis, cholecystectomy can be planned as an elective procedure.