ACUTE BILIARY PANCREATITIS - THE ROLES OF ENDOSCOPIC ULTRASONOGRAPHY AND ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Background. Acute biliary pancreatitis, particularly severe pancreatit is, necessitates urgent diagnosis and treatment of common bile duct (C BD) stones. The roles of urgent endoscopic ultrasonography (EUS) and e ndoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary pancreatitis were prospectively studied. Methods. Thirty-f ive consecutive patients with suspected acute biliary! pancreatitis un derwent urgent ultrasonography computed tomography (CT), EUS, and ERCP ! Endoscopic sphincterotomy (ES) was performed for CBD stones. We inve stigated (I) imaging diagnostic results of CBD stones and intrapancrea tic and extrapancreatic pathology and (2) the outcome of ERCP. Results . Imaging studies established a biliary origin in 24 patients, 15 with and 9 without CBD stones. According to Acute Physiology and Chronic H ealth Evaluation II scores, 6 had severe and 18 had mild pancreatitis. EUS (100 %) and ERCP (100 %) were significantly more sensitive for CB D stones than were ultrasonography (47%) and CT (47%). EUS detected pa ncreatic necrosis (100 %) as well as inflammation in the lesser sac (1 00%) and retroperitoneum (81 %), which CT confirmed. No complications related to ERCP occurred. After ES, rates of morbidity and mortality r elated to pancreatitis were 8% and 0%, respectively. Conclusions. EUS, an accurate and minimally invasive modality, may limit ERCP to therap eutic use in biliary pancreatitis. EUS is recommended if ultrasonograp hy and CT have failed to detect CBD stones. CBD stones should be treat ed with urgent ES.