PMID: 8952680Nov 9, 1996Paper

Endoscopic treatment in acute biliary pancreatitis

La Presse médicale
F PratC Buffet

Abstract

Overall mortality in acute pancreatitis is over 10%, but exceeds 40% in acute forms. In France, it has been estimated that 40 to 60% of the acute forms are of biliary origin, usually by obstruction of the pancreatic duct. Endoscopic sphincterotomy can liberate the main bile duct and separate the bile ducts from the pancreatic ducts in a minimally invasive procedure. Nevertheless, the decision to use an endoscopic treatment rather than conservative medical treatment raises several questions. Can the endoscopic technique alleviate the obstacle causing pancreatitis? Can it improve the prognosis of acute biliary pancreatitis? Which patients can best benefit from the procedure? Based on a review of the current literature, it can be concluded that endoscopic treatment improves prognosis in patients with severe pancreatitis at admission. Retrograde opacification should reasonably be associated with sphincterotomy in order to avoid leaving small stones. Endoscopy should be performed within a short delay, preferably within 24 hours following admission, by an experienced operator. Inversely, patients with less severe disease, less than 4 of Ranson's modified criteria, could benefit more from conservative management. In all cases, the dia...Continue Reading

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