Role of ERCP and endoscopic sphincterotomy in acute pancreatitis

When assessing the indications for interventional endoscopy, obstructive an d non-obstructive causes of acute pancreatitis should be distinguished. In non-obstructive (e.g. alcoholic) pancreatitis, no data are available provin g any benefit for endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy. In obstructive (e.g. biliary) pancreatitis, the pathogenetic role of gallst ones is controversial. The vast majority of gallstones initiating biliary p ancreatitis pass spontaneously through the papilla of Vater into the duoden um without causing cholangitis or obstructive jaundice. Three prospective r andomized published studies have attempted to answer the question of whethe r urgent removal of the stone improves the prognosis of patients suffering from acute pancreatitis. From these studies it can be concluded that the use of ERCP in acute biliar y pancreatitis should depend on biliary symptoms: in cases of obstructive j aundice or cholangitis, bile duct stones should be removed as soon as possi ble; in patients without biliary complications, emergency ERCP is neither b eneficial nor cost-effective; if retained stones (without biliary complicat ions) are suspected, they can be removed electively.