Indications and Timing of ERCP and Cholecystectomy for Biliary Pancreatitis
10.15279/kpba.2019.24.1.11
- Author:
Young Hoon CHOI
1
;
Sang Hyub LEE
Author Information
1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. gidoctor@snuh.org
- Publication Type:Review
- Keywords:
Biliary pancreatitis;
Endoscopic retrograde cholangiopancreatography;
Cholecystectomy;
Indication;
Timing
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde;
Cholangiopancreatography, Magnetic Resonance;
Cholangitis;
Cholecystectomy;
Common Bile Duct;
Gallstones;
Humans;
Inflammation;
Pancreatitis;
Sphincterotomy, Endoscopic;
Ultrasonography
- From:Korean Journal of Pancreas and Biliary Tract
2019;24(1):11-16
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
In acute biliary pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy should be considered to reduce the complications of gallstones including recurrent biliary pancreatitis. If biliary pancreatitis is accompanied by cholangitis or evidence of obvious biliary obstruction, removal of the common bile duct stone via early ERCP (within 24 to 72 hours) is necessary. Less or non-invasive imaging modalities such as endoscopic ultrasound, magnetic resonance cholangiopancreatography can be considered to avoid unnecessary ERCP if suspected biliary obstruction in the absence of cholangitis in patients with biliary pancreatitis. Cholecystectomy in patients with biliary pancreatitis requires a strategy that varies the timing of surgery depending on the severity of pancreatitis. In mild acute biliary pancreatitis, cholecystectomy can be performed safely at the time of initial admission. In moderate to severe biliary pancreatitis, cholecystectomy should be delayed until about 6 weeks when active inflammation subsides and fluid collections resolve or stabilize. Endoscopic sphincterotomy (EST) can be helpful in reducing recurrent pancreatitis in patients who unfit for cholecystectomy. However, even if EST is performed, additional cholecystectomy will further reduce the risk of recurrent pancreatitis, if possible, it is recommended to undergo a cholecystectomy.
