ACUTE BILIARY PANCREATITIS : ENDOSCOPIC AND SURGICAL TREATMENT.

The results of endoscopic and surgical treatment in 42 pts affected on acute biliary pancreatitis (ABP) are reported. All pts were managed according to the same protocol. Performed diagnosis (pain, serum amylase, ultrasonography) and evaluated the severity (Ranson’s criteria, glucose and urea levels), the 42 pts underwent to ERCP, within 24 hours in 16 pts (predicted severe disease) or within 72 hours in 26 pts (predicted mild disease). The endoscopic sphincterotomy (ES) was performed in 36 pts with stones in the common bile duct (CBD); it was successful in 94,5% (34 pts: 6 pts underwent more than one session to confirm or achieve CBD clearence). The morbidity was 8% (3 pts: 2 bleeding, 1 perforation). There were no deaths. The cholecistectomy was performed in 32 pts within 2-10 weeks from the initial attack of ABP. There were 3 minor complications (respiratory, laparotomy, urinary infection), no major intraoperative or postoperative morbidity, no mortality. The ABP is still associated with significant morbidity and mortality, but can be managed safely with a combined endoscopic and surgical treatment. We recommend one stop tests for severity stratification of pancreatitis and imaging within 24 hours of admission in AP in order to find the aetiology so that ERCP and sphincterotomy can be performed within 72 hours.