ABSTRACT
BACKGROUND: Controversy still exists about the role and timing of endoscopic retrograde cholangiopancreaicotography (ERCP) in mild to moderate biliary pancreatitis. Routine preoperative ERCP detects persisting common bile duct stones but is associated with definite morbidity and may delay definitive care. AIM OF STUDY: The study aims to evaluate the role of ERCP in the management of mild to moderate acute biliary pancreatitis. PATIENTS AND METHODS: The records of 196 patients with diagnosis of mild to moderate acute biliary pancreatitis (ABP) were retrospectively reviewed over four-years period. The various parameters examined were age, sex, clinical presentation, laboratory values, radiological studies, and severity of the attack, preoperative ERCP, surgical intervention and length of hospital stay. Pre operative ERCP was performed in 136 (67%) patients. Indications of ERCP were presence of jaundice, dilated common bile duct on ultrasonography, persistent hyperamylasemia, and associated cholangitis. In 17 patients with old age and multiple medical problems, ERCP served as a definite procedure. RESULTS: Mild to moderate cases accounted for 91% of ABP. Liver function tests (bilirubin, ALP, AST, ALT) were raised in 64% of cases. persistent hyperamylasemia in 4%, dilated CBD was observed in 14% associated cholangitis was present in 11%. Preoperative ERCP was positive in 22 (16%) patients, only where a CBD stones could be found and an endoscopic sphincterotomy) (ES) was performed. Positive predictive values were 25% for the high bilirubin level, 22% for the high ALP level, 50% for the persistent hyperamylasemia, 57% for the dilated CBD, 45% for the associated cholangitis. ERCP was associated with a morbidity rate of 3.6% with no mortality. The procedure was regarded as unnecessary in 84% of cases, where it increased the length of hospital stay by a mean of 2, 3 days. CONCLUSION: Preoperative ERCP was therapeutic in only 16% in cases of mild to moderate ABP. It should be done only on selective basis. In elderly patients with multiple medical problems. ERCP and ES can serve as definitive treatment.
