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Early Endoscopic Retrograde Cholangiopancreatography in Predicted Severe Acute Biliary Pancreatitis

2009; Lippincott Williams & Wilkins; Volume: 250; Issue: 1 Linguagem: Inglês

10.1097/sla.0b013e3181a77bb4

1528-1140

Hjalmar C. van Santvoort, Marc G. Besselink, Annemarie C. de Vries, Marja A. Boermeester, Kathelijn Fischer, Thomas L. Bollen, Geert A. Cirkel, Alexander F. Schaapherder, Vincent B. Nieuwenhuijs, Harry van Goor, C. Dejong, Casper H.J. van Eijck, Ben J.�M. Witteman, Bas L. Weusten, Cees J. van Laarhoven, Peter J. Wahab, Adriaan C.I.T.L. Tan, Matthijs P. Schwartz, Erwin van der Harst, Miguel A. Cuesta, Peter D. Siersema, Hein G. Gooszen, Karel J. van Erpecum,

Pancreatic and Hepatic Oncology Research

In Brief Summary Background Data: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients. Methods: We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 μmol/L] and/or dilated common bile duct) were analyzed separately. Results: Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13–0.99, P= 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08–2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49–3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19–3.12, P = 0.734). Conclusions: Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present. Early endoscopic retrograde cholangiopancreatography was compared with conservative treatment in 153 patients with predicted severe acute biliary pancreatitis. Early endoscopic retrograde cholangiopancreatography was associated with reduced complications in patients with radiological or biochemical signs of cholestasis on admission.