Risk Factors for Acute Pancreatitis in Patients With Migrating Gallstones

The role of endoscopy in the management of choledocholithiasis

“…Although data regarding the natural history of choledocholithiasis are limited, available studies indicate that 21% to 34% of common bile duct (CBD) stones will spontaneously migrate, 13,14 and migrating stones pose a moderate risk of pancreatitis (25%-36%) 13,14 or cholangitis if they obstruct the distal duct. 15 The natural history of CBD stones incidentally discovered during routine intraoperative cholangiography (IOC) at elective cholecystectomy may be less morbid than symptomatic CBD stones discovered pre-cholecystectomy.…”

Endoscopic Management of Acute Biliary Pancreatitis

“…26 As an indication of sphincter spasm and a common channel, reflux of contrast into the pancreatic duct is observed in about two-thirds of intraoperative cholangiograms. 17,18,24,27,28 Compared with controls, basal sphincter of Oddi pressures were increased significantly in 30 consecutive patients with mild ABP when measured within 24 hours of admission. 29 Impaired drainage by means of the accessory papilla also contributes to promoting pancreatic ductal obstruction.…”

The role of endoscopy in the evaluation of suspected choledocholithiasis

“…28,37,38 Failure to identify CBD stones can result in recurrent symptoms, cholangitis, and ABP. 39,40 Options for evaluation of these patients include endoscopic ultrasound (EUS), magnetic resonance cholangiography (MRC), preoperative ERC, and IOC or laparoscopic US to facilitate either removal at surgery or postoperative ERC.…”