The role of early endoscopic intervention, in the treatment of acute gallstone pancreatitis, remains controversial.
Previous randomized trials have not focused on the subgroup of patients with clinical evidence of biliopancreatic obstruction.
Dr Alejandro Oría and colleagues assessed whether early endoscopic intervention, performed in acute gallstone pancreatitis and biliopancreatic obstruction, reduces systemic and local inflammation.
The research performed a single-center randomized clinical trial between 2000 and 2005.
The team admitted 238 patients within 48 hours after the onset of acute gallstone pancreatitis.
Of these, 103 patients had a distal bile duct measuring 8 mm or more combined with a total serum bilirubin 1.20 mg/dL or more.
The team randomized 51 patients to receive endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic papillotomy for bile duct stones.
A further 52 patients were randomized to early conservative management.
Patients with clinical evidence of coexisting acute cholangitis were excluded.
The research team's outcome measures included changes in organ failure score.
|Bile duct stones at ERCP and papillotomy were found in 72%|
|Annals of Surgery|
Computed tomography severity index during the first week after admission, and incidence of local complications were also analyzed.
The researchers assessed overall morbidity and mortality.
The research team found that the incidence of bile duct stones at endoscopic retrograde cholangiopancreatography was 72%.
The team noted that 40% of patients in the early conservative management group had persisting bile duct stones at elective biliary surgery.
The researchers observed no significant differences between the 2 groups regarding changes in mean organ failure score.
There was no significant difference between the 2 groups in mean computed tomography severity index, or incidence of local complications.
In addition, the team found that overall morbidity, and mortality did not differ between the 2 groups.
Dr Oría's team concludes, “The present study failed to provide evidence that early endoscopic intervention reduces systemic and local inflammation in patients with acute gallstone pancreatitis and biliopancreatic obstruction.”
“If acute cholangitis can be safely excluded, early endoscopic intervention is not mandatory and should not be considered a standard indication.”