Gallstone pancreatitis - a critical review of current treatment strategies

This review critically analyses the role of urgent biliary decompression in the management of acute gallstone pancreatitis with the emphasis on endosc opic retrograde cholangiopancreatography (ERCP) and endoscopic sphincteroto my (ES). In an analysis of currently available prospective randomised trial s the role of routine urgent ERCP with or without ES in patients with predi cted severe pancreatitis is challenged. Patients with persistent biliary ob struction and associated cholangitis appear to be the only subgroup who may benefit from urgent biliary intervention.