Endoscopic Retrograde Cholangiopancreatography (ERCP) in Acute Biliary Pancreatitis (ABP) either with or without Concomitant Cholangitis

Abstract

Background and Aim: The use of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) without cholangitis is very debatable. This work aimed to compare the impact of ERCP on the outcome of ABP with or without cholangitis.

Method: Patients underwent ERCP for ABP were included and classified to two groups, group A with concomitant cholangitis and B without cholangitis. Data from both groups were analyzed and compared at baseline and post-ERCP. (p <0.05).

Result: Group A (n=46) showed insignificantly higher median age and less female distribution than B (n=32) (37 vs 36 years) and (69% vs 43%) respectively. Serum bilirubin and AST were significantly higher in group A than B (5.9 vs 1.9 mg/dl) & (172 vs 136 U/L) respectively. The other baseline variables: ALT, ALP, amylase, lipase, CRP and pain score had insignificant difference. Cannulation time was significantly shorter in group A vs B (9 vs 16 minutes, p=0.01). Post-ERCP there was statistically significant difference in the medians of serum bilirubin (2 vs 1.4 mg/dl), amylase (121 vs 496) and CRP (57 vs 33 mg/dl) while the rest of variables had statistically insignificant difference. Pain score did not improve in 8 patients (17%) in group A vs 12 (37%) in B (p=0.04) but the overall outcome showed no significant difference. AST, ALP, bilirubin, amylase and pain score have significantly improved in group B pre and post-ERCP.

Conclusion: ERCP is safe procedure in ABP with or without cholangitis, with no statistically significant difference regarding the clinical and biochemical outcomes.