Endoscopic retrograde cholangiopancreatography-induced and non-endoscopic retrograde cholangiopancreatography-induced acute pancreatitis: Two distinct clinical and immunological entities?

Table 1 Severity of acute pancreatitis

Mild	Absence of both (peri) pancreatic necrosis and organ failure
Moderate	Presence of sterile (peri) pancreatic necrosis and transient organ failure
Severe	Infected (peri) pancreatic necrosis or persistent organ failure

Table 2 Differences in post-endoscopic pancreatitis vs non- endoscopic retrograde cholangiopancreatography induced acute pancreatitis clinical presentation

	PEP	non-ERCP-induced AP	Conclusion
Fung et al[10] ERCP-induced acute necrotising pancreatitis vs ANP induced by other causes	Higher APACHE II scores on admission	Lower APACHE II scores on admission	ANP is more severe when ERCP-induced
	More extensive pancreatic necrosis	Less extensive pancreatic necrosis
	Higher rate of infected necrosis	Lower rate of infected necrosis
Testoni et al[12] ERCP induced AP vs non ERCP induced AP	No statistical difference: severity of the pancreatitis mortality rate (double in severe PEP) hospitalisation
	In mild form serum amylase fell 50% in 38.9 h. Peak serum amylase halved within 48 h in 92%	In mild form serum amylase fell 50% in 46, 4 h. Peak serum amylase halved within 48 h in 73.6%	Statistical difference (P < 0.001) Mild form of PEP a sort of pancreatic reaction, instead of true episode of acute pancreatitis
Abid et al[9] Mild form: ERCP induced AP vs non ERCP induced AP	Shorter duration of pain; Shorter time of intravenous hydration; Shorter time to resumption of oral diet; Shorter hospital stay (P < 0.001)		ERCP-induced AP mild attacks run a significantly shorter and milder course than non-ERCP related mild attacks

PEP: Post-endoscopic pancreatitis; ERCP: Endoscopic retrograde cholangiopancreatography; AP: Acute pancreatitis.