Endoscopic Retrograde Cholangiopancreatography in Acute Pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) was attempted in 32 patients and successfully performed in 31 patients with acute pancreatitis during the initial 12 h of hospitalization. 29% of the patients were found to have biliary pancreatitis, and in 4 patients common bile duct stones were removed. Abnormalities of the main pancreatic duct and the side branches were found in 89% of the patients with nonbiliary pancreatitis. In particular, defects in the filling of the pancreatic ducts, suggesting protein plugs and increased viscosity of the pancreatic secretion, were observed in 11 patients. In all but 1 patient a decrease of serum amylase was observed 1 day after ERCP. This preliminary study leads us to conclude that ERCP in acute pancreatitis is: (i) not harmful; (ii) detects unsuspected biliary pancreatitis better than other methods, and (iii) reveals abnormalities of the pancreatic ducts which may be of importance for the pathogenesis of nonbiliary pancreatitis.