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Whether patients who have gallstone pancreatitis without cholangitis benefit from urgent endoscopic retrograde cholangiopancreatography (ERCP) has been debated for decades. At most centers, patients with gallstone pancreatitis are evaluated for choledocholithiasis and undergo ERCP when the pancreatitis has settled down. Proponents of urgent intervention suggest that ERCP with biliary sphincterotomy can help clarify biliary anatomy, remove undetected stones, and decompress the biliary tree. Those opposed to this approach argue that ERCP in this setting should be reserved for patients with cholangitis because the procedure can exacerbate pancreatitis and has not clearly been shown to be of benefit.
To resolve this debate, investigators in the …