[Acute pancreatitis and gallstones]

Gallstones are the most common causative factor in acute pancreatitis in the Western world. The majority of patients experience a mild course of the disease, with no need for acute invasive intervention. In patients with a severe course, acute endoscopic sphincterotomy seems indicated. Acute surgical intervention is not indicated in acute pancreatitis due to gallstones. In order to aim for early endoscopic decompression early detection og gallstones and determination of the severity og acute pancreatitis is essential. For this purpose, a combination of ultrasonography and biochemical tests seems most valid. Because of the high rate of recurrence, it is important that a cholecystectomy is performed during the same admission, after the acute symptoms have subsided. In patients with gallbladder stones an endoscopic sphincterotomy may be sufficient, but this procedure has never been compared to cholecystectomy in a controlled trial. Repeated ultrasonography is necessary, due to the high rate of false negative results of ultrasonography and biochemical tests in the early phase of acute pancreatitis. With a combination of repeated ultrasonography, endoscopic retrograde cholangiopancreaticography and microscopical examination of the bile a reduction in the incidence of acute "idiopathic" pancreatitis is achieved and appropriate treatment may be initiated. Finally, one should be aware of the presence of biliary sludge. Active intervention in patients with acute pancreatitis and biliary sludge significantly reduces the risk of recurrent pancreatitis.