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Volume 336:237-242 January 23, 1997 Number 4 Next

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ABSTRACT

Background The role of early endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy in the treatment of patients who have acute biliary pancreatitis without obstructive jaundice is uncertain.

Methods We conducted a prospective, multicenter study in which 126 patients were randomly assigned to early ERCP (within 72 hours after the onset of symptoms) and endoscopic papillotomy for the removal of stones in the common bile duct, when appropriate, and 112 patients were assigned to conservative treatment. In the conservative-treatment group, ERCP was performed within three weeks if signs of biliary obstruction or sepsis developed. Overall mortality, mortality due to pancreatitis, and complications were compared in the two groups.

Results Early ERCP was successful in 121 of the 126 patients in the invasive-treatment group. Endoscopic papillotomy was performed to remove bile-duct stones in 58 patients; stones were successfully extracted in 57. ERCP was performed in 22 of the 112 patients in the conservative-treatment group; papillotomy for stone removal was successful in 13 patients. Fourteen patients in the invasive-treatment group and 7 in the conservative-treatment group died within three months (P = 0.10); 10 patients in the invasive-treatment group and 4 in the conservative-treatment group died from acute biliary pancreatitis (P = 0.16). The overall rate of complications was similar in the two groups, but patients in the invasive-treatment group had more severe complications. Respiratory failure was more frequent in the invasive-treatment group, and jaundice was more frequent in the conservative-treatment group.

Conclusions In patients with acute biliary pancreatitis but without obstructive jaundice, early ERCP and papillotomy were not beneficial.

Source Information

From the Department of Medicine, University of Kiel, Kiel, Germany (U.R.F., R.N.), and the Departments of Medical Statistics (R.L., R.A.H.) and Medicine (W.C.), University of Göttingen, Göttingen, Germany.

Address reprint requests to Dr. Fölsch at I. Medizinische Universitätsklinik, Schittenhelmstrasse 12, D-24105 Kiel, Germany.

Full Text of this Article

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Early ERCP and Papillotomy for Acute Biliary Pancreatitis
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N Engl J Med 1997; 336:1835-1836, Jun 19, 1997. Correspondence

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