Abstract

An emergency endoscopic procedure is recommended for acute biliary pancreatitis in cases with biliary obstruction by stones or cholangitis following the guidelines for medical care in acute pancreatitis in Japan. However, there are differences in the therapeutic timing and methods used among different hospitals. We examined 25 cases of acute biliary pancreatitis admitted to Showa university hospital in whom endoscopic retrograde cholangiopancreatography (ERCP) was performed within 72 hours after admission. The ages of the patients ranged from 30 to 89 years. Fourteen patients were male and 11 were female. Eleven patients had mild or moderate acute pancreatitis and 14 patients had severe acute pancreatitis according to the former clinical criteria adopted until September 2008 for severity of acute pancreatitis proposed by the research group of the Ministry of Health, Welfare, and Labour of Japan. The clinical condition of acute biliary pancreatitis was ameliorated by early endoscopic treatment, but there were no significant differences in total hospital stays, removal rates of bile duct stones and rates of endoscopic incidents between the endoscopic biliary drainage (EBD) group and the EBD with endoscopic sphincterotomy (EST) group, and between patients who underwent EBD with removal of bile duct stones and EBD prior to removal of bile duct stones. The results suggest that early ERCP is preferable for acute biliary pancreatitis with biliary obstruction by stones or cholangitis, however we have to be careful to avoid hemorrhage after EST and cholecystitis after EBD. More through investigations are required to evaluate whether EBD with EST or EBD without EST is more useful and whether EBD with stone removal or EBD prior to stone removal is more beneficial for patients.