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pancreas, five studies further included either >2cm necrotic pancreatic segment or persistent PFC/EPF as a criteria, two studies defined DPDS intraoperatively and five studies lacked a definition. The success of endoscopic or surgical intervention was defined as resolution of symptoms without recurrence of PFC, EPF or ascites. The weighted success rate among those undergoing a transmural drainage (91.6%, 95%-CI 81.2-96.5) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical drainage which were 82% (weighted 95%-CI 68.6-90.5) and 87.3% (95%-CI 79.2-92.5) respectively, (P=0.389). Conclusion: Transmural drainage was superior to transpapillary drainage for management of DPDS. Both surgery and endoscopy have comparable success rates. There remains a significant variability in the definitions and treatment strategies for DPDS.

Introduction: There is still controversies about which surgical strategy is most appropriate to resolve the underlying biliary pathology in patients with Acute Gallstone-Pancreatitis (AGP).The aim was to evaluate the safety and effectiveness of Early Laparoscopic Cholecystectomy (ELC)in patients with Mild-AGP. Methods: Retrospective cohort of consecutive patients diagnosed with mild-AGP according to the Atlanta Guidelines from January 2009 to July 2019. Patients were assigned to surgery on the first available shift after 48 hours after symptoms onset. Univariate analysis was performed to determine association between AGP and Grades of Balthazar(A,B and C)with time to surgery, days of hospitalization and postoperative complications. Results: From 239 patients evaluated, 238 (99.58%) were operated by laparoscopic approach. Intraoperative cholangiogram(IOC)was performed routinely.Common bile duct stones, if present, were simultaneously and successfully treated.Significant association were found between Balthazar-Grades and time to surgery (median of 3 days, p=0.003), with length hospitalization and from surgery to discharge, with median of 4 days (p=0.0001) and 2 days (p=0.003) respectively. Of the entire cohort, 118 patients (49.3%) were operated at 48 hours since the symptoms onset. Mild postoperative complications (CD I/II) were observed in 22/239 patients (9.2%). This represents 2% of patients with Grade A of Balthazar, 9% of grade B and 14% of grade C (p=0.016). No severe and deaths were observed. Conclusions: ELC with routine IOC and common bile duct exploration performed on the first available surgical shift after 48h since onset of pancreatitis symptoms,is a viable, effective and a safe strategy for the resolution Mild-AGP and its underlying biliary pathology.