Endoscopic sphincterotomy for acute pancreatitis: arguments in favour

Pathogenetic factors of acute biliary pancreatitis include persistent or tr ansient, absolute or relative, obstruction of Vater's ampulla or the main p ancreatic duct and reflux of bile into the pancreatic ducts or of pancreati c juice into the bile ducts. There is an increasing incidence of persisting common bile duct stones in the more severe forms of acute biliary pancreat itis, in patients who die, and in patients with pancreatic necrosis. All th ese findings provide a rational basis for the use of early biliary decompre ssion in patients with acute biliary pancreatitis. Endoscopic sphincterotom y offers a cost-effective and safe alternative to surgical biliary decompre ssion with an overall morbidity rate of 8% and mortality rate of 2.4%. Rand omized clinical trials showed that endoscopic sphincterotomy is useful in p atients with predicted severe attack of acute biliary pancreatitis and is c learly indicated in all patients who are jaundiced or who have associated c holangitis. In addition, the procedure is valid in preventing recurrent att ack of acute biliary pancreatitis in high risk elderly patients with gallst ones, unfit for any kind of cholecystectomy.