Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2015; 21(40): 11205-11208
Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11205
Role and timing of endoscopy in acute biliary pancreatitis
Andrea Anderloni, Alessandro Repici
Andrea Anderloni, Alessandro Repici, Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
Author contributions: Anderloni A designed and wrote the editorial; and Repici A contributed to review the paper.
Conflict-of-interest statement: The authors have none to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andrea Anderloni, MD, PhD, Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, 20089 Milan, Italy. andrea.anderloni@humanitas.it
Telephone: +39-2-82247308 Fax: +39-2-82242292
Received: March 8, 2015
Peer-review started: March 11, 2015
First decision: June 2, 2015
Revised: July 2, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: October 28, 2015
Processing time: 228 Days and 17 Hours
Abstract

The role and timing of endoscopy in the setting of acute biliary pancreatitis (ABP) is still being debated. Despite numerous randomized trials have been published, there is an obvious lack of consensus on the indications and timing of endoscopic retrograde cholangiopancreatography (ERCP) in ABP in meta-analyses and nationwide guidelines. The present editorial has been written to clarify the role of endoscopy in ABP. In clinical practice the decision to perform an ERCP is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct stone presence. Endoscopic ultrasonography (EUS) is not currently a worldwide standard diagnostic procedure early in the course of acute biliary pancreatitis, but it has been shown to be accurate, safe and cost effective in diagnosing biliary obstructions compared with magnetic resonance cholangiopancreatography and ERCP and therefore in preventing unnecessary ERCP and its related complications. Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.

Keywords: Acute biliary pancreatitis; Choledocolithiasis; Common bile duct stone; Endoscopic retrograde cholangiography; Endoscopic ultrasonography; Endoscopic ultrasonography

Core tip: Although several reports have been published on role and timing of endoscopy in the treatment of acute biliary pancreatitis (ABP), there are still some controversial in this subject. In clinical practice the decision to perform an endoscopic retrograde cholangiopancreatography is often based on biochemical and radiological criteria despite they already have been shown to be unreliable predictors of common bile duct (CBD) stone presence. Both magnetic resonance cholangiopancreatography and endoscopic ultrasonography (EUS) are now indicated as the best noninvasive imaging methods for CBD stone detection. Early EUS in ABP allows, if appropriate, immediate endoscopic treatment and significant spare of unnecessary operative procedures thus reducing possible related complications.