Management of Acute Biliary Pancreatitis

DOI 39 References
  • Arata Shinji
    Critical Care and Emergency Center, Yokohama City University Medical Center

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  • 胆石性膵炎の治療はどうするのか？

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We examined previous reports closely about the primary care for biliary pancreatitis, one of the important causes of the acute pancreatitis, and developed treatment guideline which were mainly changed from the first edition. For random clinical trials (RCTs) on urgent endoscopic retrograde cholangiopancreatography⁄endoscopic sphincterotomy (ERCP⁄ES) for acute biliary pancreatitis, a meta-analysis was performed according to the disease severity, and a high utility was reported for severe cases. In addition, three new related RCTs were performed. All authors reported an affirmative result in the usefulness of emergency ERCP+ES, which is believed to be useful for patients with severe acute pancreatitis and with prolongation of the passage disorder. We added a comparison of the outcome after acute biliary pancreatitis in patients treated by ERCP+ES with and without cholecystectomy. Although it was not high, the relapse rate of acute pancreatitis in the ERCP+ES treatment group, in comparison with the gall bladder extraction group, was high with the frequent recurrence of biliary tract system symptoms. Even in elderly or high-risk patients, to treat patients with ERCP+ES alone cannot be recommended as the standard treatment strategy. In most patients, cholangiography and biliary surgery should precede hospital discharge.

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