RESULTS OF ERCP IN PATIENTS WITH ACUTE AND RECURRENT BILIARY PANCREATITIS

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is accepted for diagnosis and treatment of biliary tree stones in biliary pancreatitis (BP). Timing of ERCP is controvertial for acute biliary pancreatitis (ABP). The aim of this study is to compare the results of ERCP, Ultrasonography (US) and biochemical analysis in ABP and in patients with recurrent biliary pancreatitis (RBP) who had conservative treatment. Sixty-five patients (Group I) with ABP and 21 patients (Group II) with RBP underwent ERCP. There were 49 (75%) male, 16 (25 %) female and mean age was 53±14 years (range 19 to 80) in group I. There were 12 (57%) male and 9 (43%) female patients, mean age was 54±16 years (range 25 to 80) in group II. Patients were divided into three subgroups according to the findings of US; absence of gallstone, gallstone >5 mm and multiple small stones or sludge. Besides, enlargement of common bile duct (CBD) was determined in both groups. US evaluation of the gallbladder revealed that gallstones >5 mm were the most common finding in group I (42 patients 65%), multiple small stones and sludge were the most common finding in group II (12 patients 57%). The difference was statistically significant between groups (p <0.001). There was no statistically significant difference between groups in terms of US findings. ERCP evaluation of the CBD showed no stone in group I (36 patients 55 %), multiple small stones and sludge were the most common finding in group II (9 patiens 43%). There was statistically significant difference between the groups (p= 0.004) in terms of ERCP finding. Amylase, total bilirubin, indirect bilirubin, AST, ALT, LDH, GGT and ALP levels were not different statistically in any group. Multiple small stones and sludge rate in galbladder is high in patients with RBP. Also the rate of multiple small stones and sludge in CBD was higher in patients with RBP than in patients with ABP. ERCP and sphincterotomy may reduce the recurrence rate in patients with RBP caused by multiple small stones and sludge.