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Randomized Controlled Trial
. 2009 Jul;250(1):68-75.
doi: 10.1097/SLA.0b013e3181a77bb4.

Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study

Hjalmar C van Santvoort  1 , Marc G Besselink, Annemarie C de Vries, Marja A Boermeester, Kathelijn Fischer, Thomas L Bollen, Geert A Cirkel, Alexander F Schaapherder, Vincent B Nieuwenhuijs, Harry van Goor, Cees H Dejong, Casper H van Eijck, Ben J Witteman, Bas L Weusten, Cees J van Laarhoven, Peter J Wahab, Adriaan C Tan, Matthijs P Schwartz, Erwin van der Harst, Miguel A Cuesta, Peter D Siersema, Hein G Gooszen, Karel J van Erpecum; Dutch Acute Pancreatitis Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study

Hjalmar C van Santvoort et al. Ann Surg. 2009 Jul.

Abstract

Summary background data: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients.

Methods: We performed a prospective, observational multicenter study in 8 university medical centers and 7 major teaching hospitals. One hundred fifty-three patients with predicted severe ABP without cholangitis enrolled in a randomized multicenter trial on probiotic prophylaxis in acute pancreatitis were prospectively followed. Conservative treatment or ERCP within 72 hours after symptom onset (at discretion of the treating physician) were compared for complications and mortality. Patients without and with cholestasis (bilirubin: >2.3 mg/dL [40 mumol/L] and/or dilated common bile duct) were analyzed separately.

Results: Of the 153 patients, 81 (53%) underwent ERCP and 72 (47%) conservative treatment. Groups were highly comparable at baseline. Seventy-eight patients (51%) had cholestasis. In patients with cholestasis, ERCP (52/78 patients: 67%), as compared with conservative treatment, was associated with fewer complications (25% vs. 54%, P = 0.020, multivariate adjusted odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.13-0.99, P= 0.049). This included fewer patients with >30% pancreatic necrosis (8% vs. 31%, P = 0.010). Mortality was nonsignificantly lower after ERCP (6% vs. 15%, P = 0.213, multivariate adjusted OR: 0.44, 95% CI: 0.08-2.28, P = 0.330). In patients without cholestasis, ERCP (29/75 patients: 39%) was not associated with reduced complications (45% vs. 41%, P = 0.814, multivariate adjusted OR: 1.36; 95% CI: 0.49-3.76; P = 0.554) or mortality (14% vs. 17%, P = 0.754, multivariate adjusted OR: 0.78; 95% CI: 0.19-3.12, P = 0.734).

Conclusions: Early ERCP is associated with fewer complications in predicted severe ABP if cholestasis is present.

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