Early elective endoscopic intervention

Early endoscopic intervention is required in the treatment of biliary pancr eatitis in the presence of cholangitis or jaundice, possibly with dilated c ommon bile duct. Also patients with predicted severe disease, lack of spont aneous clinical improvement or progressive jaundice might benefit from endo scopic retrograde cholangioyancreatography (ERCP) with sphincterotomy. If e ndoscopy is indicated, it should be performed as soon as possible. Injectio n of contrast medium into a dilated bile duct is accompanied by the risk of cholangitis. Therefore therapeutic decompression by sphincterotomy and sto ne extraction is necessary, or, if this is not possible, insertion of a nas o-biliary tube for drainage. Prophylactic use of antibiotics is recommended periinterventionally. Early endoscopic intervention is not necessary in pa tients with mild biliary pancreatitis and spontaneous clinical improvement. Here, ERCP can be performed later, if indicated.