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The role and timing of endoscopic retrograde cholangiopancreatography (ERCP) for patients with acute biliary pancreatitis is unclear. This multicenter randomized German trial compared early ERCP and conservative therapy (i.e., no ERCP unless signs of biliary obstruction or sepsis developed) in 238 patients with biliary pancreatitis.
Patients were included if abdominal imaging revealed gallstones or liver function tests were abnormal, there was no other obvious cause such as alcoholism, and ERCP could be done within 72 hours after symptom onset. Patients with advanced obstructive jaundice (bilirubin above 5 mg/dl) were excluded.
In the ERCP group, bile-duct stones were seen and successfully extracted with papillotomy in about half the patients…