Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone‐induced acute cholangitis and pancreatitis

Abstract

Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.

Impact of the COVID‐19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single‐center retrospective study in Japan

“…7 Biliary decompression via ERCP is recommended as the initial treatment for patients with acute cholangitis. The incidence of choledocholithiasis, the most common cause of acute cholangitis, 8 , 9 has recently increased due to the aging of the population. 10 Although choledocholithiasis may be asymptomatic, it causes cholangitis, pancreatitis, and obstructive jaundice in many patients.…”

Predictive value of bile acids as metabolite biomarkers for gallstones: A protocol of systematic review and meta-analysis

“…Cholesterol cholelithiasis is the main type, which are composed of a higher percentage of cholesterol and calcium salts of bilirubin and phosphates [ 4 ]. Due to the huge change of lifestyle and economic development, the prevalence rate of gallstones keeps increasing worldwide year by year, consequently the risks of the severe complications such as cholecystitis and pancreatitis rise as well [ 5 , 6 ]. In addition, gallstone is reported to be the most important risk factor for gallbladder cancer (GBC) [ 7 ], which leads to a huge financial burden.…”

Evaluation of Different Types of Gallstones Extracted by Endoscopic Retrograde Cholangiopancreatography

“…Intrahepatic stones are usually brown pigmented stones while gall bladder stones are mainly cholesterol stones and less commonly pigmented stones. 6 Mixed cholesterol stones are mostly found in the bile duct. Patients with bile duct stones usually present with biliary colic, cholangitis, obstructive jaundice and pancreatitis.…”