Refining the Indications for ERCP in Biliary Pancreatitis

According to a guideline from the American Gastroenterological Association, “ERCP [endoscopic retrograde cholangiopancreatography] should be urgently performed when acute cholangitis has complicated acute biliary pancreatitis [. . . and] when clinical or radiographic features suggest a persistent common bile duct stone.” For patients without these findings — but with pancreatitis that is predicted to be severe — the guideline notes that early ERCP is more controversial (Gastroenterology 2007; 132:2022). In a prospective observational study from the Netherlands, researchers address this controversy.

Researchers enrolled 153 patients who had acute severe biliary pancreatitis (according to scoring systems such as APACHE-II) but who showed no ev…