Early ERCP and Papillotomy Compared with Conservative Treatment for Acute Biliary Pancreatitis

Fölsch, Ulrich R.; Nitsche, R.; Lüdtke, Rainer; Hilgers, Reinhard; Creutzfeldt, W.

doi:10.1056/nejm199701233360401

Cited by 560 publications

(274 citation statements)

References 20 publications

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“…With the exception of critically ill patients with suspected ascending cholangitis, the usefulness of performing ERCP early in the course of biliary pancreatitis is controversial (12,13). In this respect, ERCP delay until biliary pancreatitis resolution may be a common practice.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL.Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL.Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/ sludge. The performance of ASGE high-and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI,.Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

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Section: Discussionmentioning

confidence: 99%

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Rivera¹,

Gonzalez²,

Monreal-Robles³

et al. 2016

Rev Esp Enferm Dig

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“…These studies have compared early ERCP with biliary sphincterotomy with delayed or selective ERCP (240)(241)(242). Inclusion criteria and presence of bile duct stones vary considerably among these trials.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

“…One interpretation is that there is a strong correlation between persistent biliary obstruction and more severe disease (245). Hence, common bile duct stones were seen more often in the two positive studies (240,242) than in the negative study (241). Retained common bile duct stones could lead to organ failure by causing ascending cholangitis or by causing intensification of the pancreatitis if a gallstone is blocking the pancreatic duct.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,662

980

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“…On the one hand, it is possible that advancing technology and overall improved quality of medical care allow for better outcomes, but on the other hand, more aggressive approaches in the elderly and in those patients with higher numbers of medical coexisting conditions might confer a worse prognosis. Public reports of complications and mortality rates after endoscopic biliary sphincterotomies mainly belong to the last decades of the twentieth century (3)(4)(5). Recent literature on the topic mostly focuses on comparing the outcomes after endoscopic biliary dilation vs endoscopic biliary sphincterotomies alone (6)(7)(8), but in our own experience the numbers of patients undergoing one or another procedure are very dissimilar.…”

Section: Introductionmentioning

confidence: 99%

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

et al. 2016

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We aimed to compare incidence and outcomes for endoscopic biliary sphincterotomies in people with or without type 2 diabetes mellitus (T2DM) in Spain (2003Spain ( -2013.We collected all cases of endoscopic biliary sphincterotomies using national hospital discharge data and evaluated annual incidence rates stratified by T2DM status. We analyzed trends over time for in-hospital mortality (IHM) as the primary outcome and a composite of IHM or procedure-related complications (key secondary outcome). In multivariate analyses, we tested T2DM as an independent factor of IHM and IHM or complications.We identified 126,885 endoscopic biliary sphincterotomies (23,002 [18.1%] in T2DM people). Crude incidence rates of endoscopic biliary sphincterotomies were > 3-fold higher in people with vs without T2DM (85.5/10 5 vs 26.9/10 5 population, respectively). Annual incidence rates of endoscopic biliary sphincterotomies showed 11-year relative increments of 77.5% (from 60.0 to 106.5/105) in T2DM, and 53.7% (from 21.6 to 33.2/105) in non-T2DM people (p < 0.001). We found no significant changes in mortality trends over time for the populations with or without T2DM (p = 0.15 and p = 0.21, respectively). Rates of procedural pancreatitis decreased in people without T2DM (p < 0.001). In the multivariate analysis, older age, higher comorbidity and endoscopic biliary sphincterotomy during urgent admission were associated with a higher IHM. T2DM was associated with a lower IHM after an endoscopic biliary sphincterotomy Further studies are needed to confirm a lower IHM for endoscopic biliary sphincterotomies in people with T2DM.

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Early ERCP and Papillotomy Compared with Conservative Treatment for Acute Biliary Pancreatitis

Abstract: In patients with acute biliary pancreatis but without obstructive jaundice, early ERCP and sphincterotomy were not beneficial.

Cited by 560 publications

References 20 publications

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Practice Guidelines in Acute Pancreatitis

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

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