Endoscopic retrograde cholangiopancreatography in the diagnosis of unexplained pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) was performed on 73 patients with "idiopathic" pancreatitis to define its role after routine examination failed to yield an underlying cause. Twenty-three of 73 patients with unexplained pancreatitis had potentially curable disease diagnosed by ERCP. Nine patients had biliary calculi and five had stenosis of the ampulla of Vater. Three had nonampullary strictures of the main pancreatic duct. An additional five patients had the congenital anomaly of pancreas divisum. In all eight cases, pancreatic duct abnormalities were managed nonoperatively. The ERCP commonly shows underlying cause in unexplained pancreatitis. Major abnormalities of pancreatic ducts may frequently be followed up without surgery if treatable disease of the biliary tree or ampulla of Vater can be excluded. In mild, rapidly resolved pancreatitis, ERCP may have too low a yield to justify its routine use.