Early Endoscopic Retrograde Cholangiopancreatography in Predicted Severe Acute Biliary Pancreatitis: A Prospective Multicenter Study

H.C. van Santvoort, M.G. Besselink, A.C. de Vries, M.A. Boermeester, K. Fischer, T.L. Bollen, G.A. Cirkel, A.F. Schaapherder, V.B. Nieuwenhuijs, H. van Goor, C.H. Dejong, C.H. van Eijck, B.J. Witteman, B.L. Weusten, C.J. van Laarhoven, P.J. Wahab, A.C. Tan, M.P. Schwartz, E. van der Harst, M.A. CuestaP.D. Siersema, H.G. Gooszen, K.J. van Erpecum

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    Abstract

    SUMMARY BACKGROUND DATA:: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients. METHODS:: We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 mumol/L] and/or dilated common bile duct) were analyzed separately. RESULTS:: Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P = 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734). CONCLUSIONS:: Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present.
    Original languageEnglish
    Pages (from-to)68-75
    JournalAnnals of Surgery
    Volume250
    Issue number1
    DOIs
    Publication statusPublished - 1 Jan 2009

    Cite this

    van Santvoort, H. C., Besselink, M. G., de Vries, A. C., Boermeester, M. A., Fischer, K., Bollen, T. L., Cirkel, G. A., Schaapherder, A. F., Nieuwenhuijs, V. B., van Goor, H., Dejong, C. H., van Eijck, C. H., Witteman, B. J., Weusten, B. L., van Laarhoven, C. J., Wahab, P. J., Tan, A. C., Schwartz, M. P., van der Harst, E., ... van Erpecum, K. J. (2009). Early Endoscopic Retrograde Cholangiopancreatography in Predicted Severe Acute Biliary Pancreatitis: A Prospective Multicenter Study. Annals of Surgery, 250(1), 68-75. https://doi.org/10.1097/SLA.0b013e3181a77bb4