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World J Gastrointest Endosc. Sep 16, 2010; 2(9): 308-313
Published online Sep 16, 2010. doi: 10.4253/wjge.v2.i9.308
ERCP in acute pancreatitis: What takes place in routine clinical practice?
Armando Gabbrielli, Raffaele Pezzilli, Generoso Uomo, Alessandro Zerbi, Luca Frulloni, Paolo De Rai, Laura Castoldi, Guido Costamagna, Claudio Bassi, Valerio Di Carlo
Armando Gabbrielli, Luca Frulloni, Claudio Bassi, Department of Surgical and Gastroenterological Sciences, University of Verona, Verona 37100, Italy
Raffaele Pezzilli, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna 40138, Italy
Generoso Uomo, Department of Internal Medicine, Ospedale A. Cardarelli, Naples 80100, Italy
Alessandro Zerbi, Department of Surgery, Humanitas Hospital, Milan 20100, Italy
Paolo De Rai, Laura Castoldi, Department of Emergency Surgery, Fondazione IRCCS Maggiore, Mangiagalli and Regina Elena Hospital, Milan 20100, Italy
Guido Costamagna, Digestive Endoscopy Unit, “Agostino Gemelli” University Hospital, Catholic University of Rome, Rome 00100, Italy
Valerio Di Carlo, Department of Surgery, University Vita e Salute, IRCCSS. Raffaele, Milan 20100, Italy
Author contributions: Gabbrielli A, Pezzilli R, Uomo G, Zerbi A, Frulloni L, De Rai P, Castoldi L, Costamagna G, Bassi C and Di Carlo V designed the study, coordinated and collected all the human material and revised the data; Pezzilli R and Gabbrielli A analyzed the data and interpreted the results; and Pezzilli R and Gabbrielli A wrote the manuscript.
Supported by an Unrestricted Grant from Sanofi-Aventis, Milan, Italy
Correspondence to: Raffaele Pezzilli, MD, Department of Digestive Diseases and Internal Medicine, Sant’Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, Bologna 40138, Italy. raffaele.pezzilli@aosp.bo.it
Telephone: : +39-51-6364148 Fax: +39-51-6364148
Received: May 17, 2010
Revised: August 19, 2010
Accepted: August 26, 2010
Published online: September 16, 2010
AIM: To evaluate the data from a survey carried out in Italy regarding the endoscopic approach to acute pancreatitis in order to obtain a picture of what takes place after the release of an educational project on acute pancreatitis sponsored by the Italian Association for the Study of the Pancreas.
METHODS: Of the 1 173 patients enrolled in our survey, the most frequent etiological category was biliary forms (69.3%) and most patients had mild pancreatitis (85.8%).
RESULTS: 344/1 173 (29.3%) underwent endoscopic retrograde cholangiopancreatography (ERCP). The mean interval between the onset of symptoms and ERCP was 6.7 ± 5.0 d; only 89 examinations (25.9%) were performed within 72 h from the onset of symptoms. The main indications for ERCP were suspicion of common bile duct stones (90.3%), jaundice (44.5%), clinical worsening of acute pancreatitis (14.2%) and cholangitis (6.1%). Biliary and pancreatic ducts were visualized in 305 patients (88.7%) and in 93 patients (27.0%) respectively. The success rate in obtaining a cholangiogram was statistically higher (P = 0.003) in patients with mild acute pancreatitis (90.6%) than in patients with severe disease (72.2%). Biliary endoscopic sphincterotomy was performed in 295 of the 305 patients (96.7%) with no difference between mild and severe disease (P = 0.985). ERCP morbidity was 6.1% and mortality was 1.7%; the mortality was due to the complications of acute pancreatitis and not the endoscopic procedure.
CONCLUSION: The results of this survey, as with those carried out in other countries, indicate a lack of compliance with the guidelines for the indications for interventional endoscopy.
