Endoscopic sphincterotomy for acute pancreatitis: arguments in favour

Pathogenetic factors of acute biliary pancreatitis include persistent or transient, absolute or relative, obstruction of Vater's ampulla or the main pancreatic duct and reflux of bile into the pancreatic ducts or of pancreatic juice into the bile ducts. There is an increasing incidence of persisting common bile duct stones in the more severe forms of acute biliary pancreatitis, in patients who die, and in patients with pancreatic necrosis. All these findings provide a rational basis for the use of early biliary decompression in patients with acute biliary pancreatitis. Endoscopic sphincterotomy offers a cost-effective and safe alternative to surgical biliary decompression with an overall morbidity rate of 8% and mortality rate of 2.4%. Randomized clinical trials showed that endoscopic sphincterotomy is useful in patients with predicted severe attack of acute biliary pancreatitis and is clearly indicated in all patients who are jaundiced or who have associated cholangitis. In addition, the procedure is valid in preventing recurrent attack of acute biliary pancreatitis in high risk elderly patients with gallstones, unfit for any kind of cholecystectomy.