[Endoscopic papillotomy for acute pancreatitis caused by biliary disease (author's transl)]

In 15 patients with acute pancreatitis caused by biliary disease endoscopic sphincterotomy was performed after diagnostic ERCP. All patients had a history of symptoms pointing to long-standing biliary disease, such as typical right-sided upper abdominal pain, signs of biliary stasis, and jaundice. An impacted solitary ampullar stone was demonstrated in eight patients while in seven several stones were found in the biliary tract. In one patient pancreaticogram also revealed a gall-stone which had slipped in Wirsung's duct. After endoscopic sphincterotomy and extraction of stone rapid and marked improvement occurred in all 15 patients and the biochemical abnormalities were restored towards normal. All patients became pain-free immediately after the procedure. The markedly raised levels of serum-alpha-amylase (mean of 21 700 U/l immediately before the procedure) fell tonormal values within 48 hours (400--3000 U/l). Endoscopic sphincterotomy is thus an alternative to early operation in acute pancreatitis of biliary origin.