CURRENT STATUS AND PROBLEMS OF EMERGENCY ENDOSCOPY FOR PANCREATICOBILIARY DISEASES

Abstract

Pancreaticobiliary diseases, such as acute cholangitis, acute biliary pancreatitis, and acute cholecystitis, may require emergency endoscopy. Indications for urgent endoscopic retrograde pancreaticocholangiography (ERCP) include severe acute cholangitis, acute biliary pancreatitis with cholangitis, and acute cholecystitis in patients who are unfit for surgery and percutaneous transhepatic gallbladder drainage. Endoscopic biliary drainage for moderate and severe acute cholangitis should be performed early and immediately, respectively. In patients who have acute biliary pancreatitis with biliary obstruction but without acute cholangitis, early but not urgent ERCP is indicated. Selection of drainage methods and the timing should be determined according to institutional resources; the most familiar drainage method should be selected. New biliary drainage methods (single or double balloon enteroscopy assisted ERCP and endoscopic ultrasound assisted biliary drainage) should be performed at tertiary referral hospitals with experienced hands.