Background Most patients with acute biliary pancreatitis havestones in the biliary tract or ampulla of Vater. Because thesestones may be passed spontaneously soon after a patient is admittedto the hospital, the importance of early operative removal isnot known. We tested the hypothesis that endoscopic papillotomywithin 24 hours of admission decreased the incidence of complicationsin patients with acute biliary pancreatitis.
Methods We studied 195 patients with acute pancreatitis whowere randomly assigned to one of two groups: 97 patients underwentwithin 24 hours after admission emergency endoscopic retrogradecholangiopancreatography (ERCP) followed by endoscopic papillotomyfor ampullary and common-bile-duct stones, and 98 patients receivedinitial conservative treatment and selective ERCP with or withoutendoscopic papillotomy only if their condition deteriorated.
Results One hundred twenty-seven patients ultimately provedto have biliary stones. Emergency ERCP with or without endoscopicpapillotomy resulted in a reduction in biliary sepsis as comparedwith conservative treatment (0 of 97 patients vs. 12 of 98 patients,P = 0.001). The decrease in biliary sepsis occurred both inpatients predicted to have mild pancreatitis (0 of 56 patientsin the group that received emergency ERCP vs. 4 of 58 patientsin the conservative-treatment group, P = 0.14) and in patientspredicted to have severe pancreatitis (0 of 41 patients vs.8 of 40 patients, P = 0.008). In all patients who had unrelentingbiliary sepsis, persistent ampullary or common-bile-duct stoneswere identified. There were no major differences in the incidenceof local complications (10 patients in the group that receivedemergency ERCP vs. 12 patients in the conservative-treatmentgroup) or systemic complications (10 patients vs. 14 patients)of acute pancreatitis between the two groups, but the hospitalmortality rate was slightly lower in the group undergoing emergencyERCP with or without endoscopic papillotomy (5 patients vs.9 patients, P = 0.4).
Conclusions Emergency ERCP with or without endoscopic papillotomyis indicated in the treatment of patients with acute pancreatitis.
Source Information
From the Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, where reprint requests should be addressed to Dr. Fan.
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