Acute biliary pancreatitis: the roles of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography.

摘要

BACKGROUND: Acute biliary pancreatitis, particularly severe pancreatitis, necessitates urgent diagnosis and treatment of common bile duct (CBD) stones. The roles of urgent endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of biliary pancreatitis were prospectively studied. METHODS: Thirty-five consecutive patients with suspected acute biliary pancreatitis underwent urgent ultrasonography, computed tomography (CT), EUS, and ERCP. Endoscopic sphincterotomy (ES) was performed for CBD stones. We investigated (1) imaging diagnostic results of CBD stones and intrapancreatic and extrapancreatic pathology and (2) the outcome of ERCP. RESULTS: Imaging studies established a biliary origin in 24 patients, 15 with and 9 without CBD stones. According to Acute Physiology and Chronic Health Evaluation II scores, 6 had severe and 18 had mild pancreatitis. EUS (100%) and ERCP (100%) were significantly more sensitive for CBD stones than were ultrasonography (47%) and CT (47%). EUS detected pancreatic necrosis (100%), as well as inflammation in the lesser sac (100%) and retroperitoneum (81%), which CT confirmed. No complications related to ERCP occurred. After ES, rates of morbidity and mortality related to pancreatitis were 8% and 0%, respectively. CONCLUSIONS: EUS, an accurate and minimally invasive modality, may limit ERCP to therapeutic use in biliary pancreatitis. EUS is recommended if ultrasonography and CT have failed to detect CBD stones. CBD stones should be treated with urgent ES.