El intervencionismo precoz no operatorio en la pancreatitis biliar: nuevo enfoque fundamentado en un clasico planteamiento suramericano / Early non surgical interventionism in biliary pancreatitis: new approach based on a classic south american statement

RESUMO

Human acute pancreatitis associated with gallstones is due to obstruction of the ampulla of Vater caused by migrating gallstones. The degree and duration of the obstruction determine the severity of the inflamatory reaction of the ampulla and the severity of the pancreatic damage. Even though its is recognized that impacted or migrating stones arte the cause of acute pancreatitis, and that therefore the inmediate removal of stones and the opening of the ampullary obstruction is the logical approach, it is commonly favores initial nonoperative therapy and the operation is only undertaken when the acute pancreatitis has subsided. As an innovative approach endoscopic sphincterotomy apears as an alternative for the early removal of stones from the bile duct and the opening and relief of the pathologically altered ampullary region. Perhaps this approach of early endoscopic interventionism, if supported by prospective studies, represents a breakthrough. Will surgical procedures for gallstone associated pancreatitis become a thing of the past?