Endoscopic ultrasound (EUS) dependent decision to perform endoscopic retrograde cholangiopancreatography (ERCP) in biliary pancreatitis without cholestasis on conventional imaging

Introduction In patients with acute biliary pancreatitis (ABP) with cholangitis or biliary obstruction, an early ERCP is recommended.

Aim To assess the outcome of ABP patients using EUS for deciding to perform an ERCP or not.

Methods Our prospective study included ABP patients without cholangitis or obvious cholestasis on conventional imaging admitted to our Department between 01/2018-03/2021. Biliary etiology was defined as the presence of at least one of the following three criteria: a) gallstones, b) history of cholecystectomy, or c) elevated liver enzymes (ALT, AST and/or AP >2 x ULN), without recent excessive alcohol consumption. All patients were first evaluated by EUS, and in cases where choledocholithiasis was diagnosed, an ERCP was performed subsequently.

Results 81 ABP patients with a mean age of 63.5 ± 18.1 years (51.8 % female) were included. Gallstones were diagnosed in 80.2 % of cases, and 19.8 % had previously undergone cholecystectomy. By EUS, choledocholithiasis was diagnosed in 32/81 (39.5 %) patients. ERCP could be successfully performed in 29/32 (90.6 %) of these cases. We did not observe ABP-related mortality in our cohort. Development of severe pancreatitis, organ failure, cholangitis, readmission because of biliary complications, and hospital stay were similar in patients with choledocholithiasis in EUS (and consecutive ERCP) compared to those without choledocholithiasis in EUS (and no ERCP, Table). Two out of three patients (66.6 %) with choledocholithiasis diagnosed by EUS and unsuccessful ERCP developed severe pancreatitis with persistent organ failure and intensive care admission.

Conclusion EUS is a very good method for diagnosing choledocholithiasis in ABP patients without obvious cholestasis on conventional imaging and helps to decide whether ERCP is needed or not.

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Artikel online veröffentlicht:
01. September 2021