Common bile duct stones in acute biliary pancreatitis: an endoscopic study

The knowledge of the natural history of common bile duct stones in biliary pancreatitis may be helpful in the debate concerning the timing of endoscopic sphincterotomy in relation to surgery. The endoscopic cholangiographies of 211 patients with biliary pancreatitis were analyzed. The presence of bile duct stones was recorded, as well as the time interval between admission and endoscopic retrograde cholangiopancreatography (ERCP). The predicted severity of pancreatitis was determined by the modified Glasgow criteria. The overall incidence of bile duct stones was 28.9%. This incidence was 43.8% during the first 2 days and decreased to < 20% after 1 week. There was no correlation between the severity of disease and the presence of bile duct stones. The performance of an ERCP 1 week after the admission for biliary pancreatitis will avoid a substantial number of unnecessary endoscopic sphincterotomies. Prediction of the severity of disease does not alter the yield of bile duct stones.