[Therapeutic strategy in acute pancreatitis (I). Endoscopic possibilities]

Ampullary obstruction due to bile duct stones with consecutive bilio-pancreatic reflux probably plays a major role in the pathogenesis of acute biliary pancreatitis. Because of this presumable pathogenesis endoscopic papillotomy in several clinical studies has proven to be effective. At the Department of Medicine, University of Erlangen-Nürnberg, since 1979 27 patients with suspicion of biliary pancreatitis have been examined by means of ERCP. In 15 patients common bile duct stones could be verified; these patients underwent endoscopic papillotomy. Their clinical course could be influenced favorably. The remaining patients had a temporary bile duct obstruction. Spontaneous stone passage apparently led to a quick reduction of clinical symptoms. The problem of endoscopic papillotomy in biliary pancreatitis is discussed using a patient with gallbladder stones but failure to verify common bile duct stones.