Early ERCP vs. Conservative Management in Gallstone Pancreatitis

A randomized trial suggests that early ERCP confers no advantage, even when there is evidence of ductal obstruction.

For patients with acute gallstone pancreatitis, whether there is a need for early endoscopic retrograde cholangiopancreatography (ERCP) remains controversial (Journal Watch Feb 7 1997). This randomized trial included 103 patients with acute gallstone pancreatitis and evidence of obstruction (i.e., distal common bile duct measuring ≥8 mm on ultrasound, and total bilirubin >=1.2 mg/dL). Patients with presumed cholangitis (i.e., right upper quadrant pain, hyperbilirubinemia, and temperature ≥38.4°C) were excluded.

Patients were randomized to receive early ERCP (within 72 hours of symptom onset) or early conservative management. Two conservative-management patients crossed over to early ERCP because of cholangitis and rapidly progressive jaundic…

Reviewing Author

Allan S. Brett, MD