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World J Gastrointest Endosc. Oct 15, 2009; 1(1): 17-20
Published online Oct 15, 2009. doi: 10.4253/wjge.v1.i1.17
Endoscopic sphincterotomy in acute biliary pancreatitis: A question of anesthesiological risk
Raffaele Pezzilli
Raffaele Pezzilli, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, Bologna 40138, Italy
Author contributions: Pezzilli R alone contributed to this work.
Correspondence to: Raffaele Pezzilli, MD, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy.
Telephone: +39-51-6364148 Fax: +39-51-6364148
Received: February 1, 2009
Revised: March 16, 2009
Accepted: March 23, 2009
Published online: October 15, 2009

Two consecutive surveys of acute pancreatitis in Italy, based on more than 1000 patients with acute pancreatitis, reported that the etiology of the disease indicates biliary origin in about 60% of the cases. The United Kingdom guidelines report that severe gallstone pancreatitis in the presence of increasingly deranged liver function tests and signs of cholangitis (fever, rigors, and positive blood cultures) requires an immediate and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). These guidelines also recommend that patients with gallstone pancreatitis should undergo prompt cholecystectomy, possibly during the same hospitalization. However, a certain percentage of patients are unfit for cholecystectomy because advanced age and presence of comorbidity. We evaluated the early and long-term results of endoscopic intervention in relation to the anesthesiological risk for 87 patients with acute biliary pancreatitis. All patients underwent ERCP and were evaluated according to the American Society of Anesthesiology (ASA) criteria immediately before the operative procedure. The severity of acute pancreatitis was positively related to the anesthesiological grade. There was no significant relationship between the frequency of biliopancreatic complications during the follow-up and the ASA grade. The frequency of cholecystectomy was inversely related to the ASA grade and multivariate analysis showed that the ASA grade and age were significantly related to survival. Finally, endoscopic treatment also appeared to be safe and effective in patients at high anesthesiological risk with acute pancreatitis. These results further support the hypothesis that endoscopic sphincterotomy might be considered a definitive treatment for patients with acute biliary pancreatitis and an elevated ASA grade.

Keywords: Acute biliary pancreatitis, Anesthesiological risk, Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy