{ "schemaVersion": 2, "eyebrow": "Gastroenterology", "title": "ERCP in Acute Pancreatitis", "summary": "ERCP is a therapeutic, not routine diagnostic, procedure in acute pancreatitis. Perform urgent biliary drainage for cholangitis, use selective intervention for persistent obstruction, and avoid routine early ERCP when neither is present because it adds procedural risk without demonstrated benefit.", "seoDescription": "Physician guide to ERCP indications in acute biliary pancreatitis, including cholangitis, persistent obstruction, imaging selection, timing, and procedural risks.", "clinicalQuestion": "When should ERCP be performed in patients with acute pancreatitis suspected to have a biliary cause?", "specialty": "Gastroenterology", "audience": "U.S. physicians and medical trainees", "tags": [ "acute biliary pancreatitis", "ERCP indications", "cholangitis", "choledocholithiasis", "biliary obstruction", "EUS", "MRCP" ], "keyTakeaways": [ "Perform urgent therapeutic ERCP when acute biliary pancreatitis is complicated by cholangitis; biliary drainage and stone extraction or stenting address the obstructed infected duct. [3][8]", "Do not use routine early ERCP for unselected acute gallstone pancreatitis without cholangitis or evidence of persistent biliary obstruction; randomized evidence did not show significant reductions in mortality or local/systemic complications. [9][21]", "For suspected retained common bile duct stones without an immediate drainage indication, use EUS or MRCP to establish a therapeutic target rather than diagnostic ERCP. [10][23][24]", "Reserve ERCP for patients with a reasonable likelihood of therapeutic intervention because adverse events occur in 6% to 15%; pancreatitis, bleeding, infection, and perforation are principal complications. [10][19]", "Biliary sludge and microlithiasis can cause biliary colic, cholangitis, and pancreatitis; EUS is useful when standard evaluation is unrevealing. [1][2][24]" ], "sections": [ { "id": "immediate-erCP-indications", "eyebrow": "Immediate triage", "heading": "Which acute pancreatitis patients need urgent ERCP?", "intro": "The decision turns on cholangitis or clinically consequential persistent biliary obstruction.", "paragraphs": [ "Perform urgent therapeutic ERCP in acute biliary pancreatitis with acute cholangitis. Cholangitis is bacterial infection superimposed on biliary obstruction, most commonly from common bile duct stones; initial management requires antibiotics followed by adequate biliary drainage, preferably by ERCP. Untreated mortality has been reported as high as 50%, whereas mortality below 2% is achievable with adequate treatment. [8]", "Treat severe gallstone pancreatitis with progressively deranged liver tests plus cholangitis features—fever, rigors, or positive blood cultures—as an immediate ERCP indication. At ERCP, perform common bile duct evaluation and achieve drainage with sphincterotomy, stone extraction, or biliary stenting as anatomically required. [3]", "In acute biliary pancreatitis with biliary obstruction but no cholangitis, select ERCP for a persistent obstruction phenotype rather than automatically performing it at presentation. A study comparing timing strategies found urgent ERCP was not superior to early ERCP in biliary obstruction without cholangitis; timing should be individualized to illness severity, obstruction suspicion, and response to initial conservative management. [16][9]" ], "bullets": [ "Proceed directly to therapeutic ERCP when cholangitis coexists with acute biliary pancreatitis. [3][8]", "During urgent ERCP, plan a drainage endpoint: stone extraction, sphincterotomy when indicated, or stent placement if extraction is not achievable. [3]", "Do not delay source control for cross-sectional confirmation when the clinical syndrome is obstructive cholangitis. [3][8]" ], "subsections": [], "table": { "caption": "ERCP selection in suspected acute biliary pancreatitis. [3][9][10][16][21][24]", "columns": [ "Clinical branch", "ERCP decision", "Next action" ], "rows": [ [ "Acute pancreatitis with cholangitis", "Urgent therapeutic ERCP. [3][8]", "Drain the bile duct with stone extraction, sphincterotomy, or stenting as required. [3][8]" ], [ "Biliary obstruction without cholangitis", "Selective early ERCP; urgent ERCP has not shown superiority over early ERCP in this subgroup. [16]", "Assess whether obstruction persists and use EUS or MRCP if diagnostic clarification will determine need for therapy. [9][10]" ], [ "Gallstone pancreatitis without cholangitis or evidence of persistent obstruction", "No routine early ERCP. [9][21]", "Use conservative pancreatitis management and noninvasive/endoscopic imaging selectively for retained duct stones. [10][21][24]" ], [ "Unclear biliary cause or possible microlithiasis after unrevealing initial evaluation", "Avoid diagnostic ERCP alone. [10][24]", "Use EUS, which can identify bile duct stones, sludge, microlithiasis, pancreatic lesions, chronic pancreatitis features, and pancreas divisum. [1][2][24]" ] ] } }, { "id": "avoid-routine-erCP", "eyebrow": "Evidence boundary", "heading": "When early ERCP should be avoided", "intro": "Most patients with gallstone pancreatitis do not benefit from routine duct instrumentation.", "paragraphs": [ "Avoid routine early ERCP in unselected acute gallstone pancreatitis. In a Cochrane review, early routine ERCP versus early conservative management did not produce statistically significant differences in mortality (risk ratio 0.74, 95% CI 0.18-3.03), local complications (risk ratio 0.86, 95% CI 0.52-1.43), or systemic complications (risk ratio 0.59, 95% CI 0.31-1.11). [21]", "The absence of cholangitis does not itself exclude a retained duct stone, but it removes the immediate source-control rationale for ERCP. In this setting, establish whether a treatable ductal lesion is present before exposing the patient to an invasive procedure whose overall adverse-event rate is 6% to 15%. [10]", "Routine diagnostic ERCP has been displaced by EUS and MRCP. Detection rates for choledocholithiasis with ERCP, MRCP, and EUS are reported as comparable at greater than 90%, while EUS may better demonstrate microlithiasis that can be masked by contrast during ERCP. [24]" ], "bullets": [ "Do not equate gallstone pancreatitis with an automatic ERCP indication. [9][21]", "Do not use ERCP solely to search for a common bile duct stone when EUS or MRCP can determine whether therapeutic ERCP is needed. [10][23][24]", "Reconsider ERCP if the patient develops cholangitis or objective evidence supports persistent obstruction. [3][9]" ], "subsections": [], "table": { "caption": "Why diagnostic confirmation should usually precede ERCP in stable patients. [10][23][24]", "columns": [ "Test", "Clinical role", "Decision consequence" ], "rows": [ [ "EUS", "Second-step evaluation for occult biliary disease, including sludge, microlithiasis, stones, pancreatic abnormalities, and pancreas divisum. [1][2][24]", "Positive treatable ductal finding supports therapeutic ERCP; negative examination can avoid ERCP. [2][10]" ], [ "MRCP", "Noninvasive biliary imaging; one study reported 91% sensitivity, 98% specificity, and 97% diagnostic accuracy for choledocholithiasis. [23]", "Use to select patients for therapeutic ERCP when immediate drainage is not required. [23]" ], [ "ERCP", "Therapeutic duct access with ability to extract stones, perform sphincterotomy, or place a stent. [3][10]", "Use when drainage or another endoscopic intervention is likely, not as a default diagnostic test. [10][24]" ] ] } }, { "id": "biliary-workup", "eyebrow": "Diagnostic pathway", "heading": "How to evaluate suspected retained stones before ERCP", "intro": "Use clinical trajectory and targeted imaging to distinguish passed stones from persistent duct disease.", "paragraphs": [ "Obtain transabdominal ultrasound, clinical chemistry including liver tests, serum triglycerides and calcium, a complete prescription and over-the-counter medication review, and cross-sectional abdominal imaging as part of etiologic evaluation in acute pancreatitis. If this initial evaluation does not establish a cause and biliary disease remains plausible, advance to EUS or MRCP rather than diagnostic ERCP. [2]", "Choose EUS when occult stones, biliary sludge, or microlithiasis are leading concerns. Biliary sludge and microlithiasis may cause clinically significant pain, cholangitis, and pancreatitis; microlithiasis is often categorized clinically as small gallstones. [1] In idiopathic acute recurrent pancreatitis, EUS diagnostic yield was 75% in one study, and biliary tract disease was the most common treatable etiology. [2]", "Choose MRCP when a noninvasive ductal map will answer the retained-stone question or define obstruction before intervention. MRCP can select patients with choledocholithiasis for therapeutic ERCP, avoiding procedure-related morbidity in patients without an actionable lesion. [23][24]", "Use ERCP after EUS or MRCP when findings identify a ductal stone or obstruction requiring drainage. If imaging suggests a nonstone obstructive process, ERCP may provide direct ampullary evaluation and biopsy capability, whereas MRCP is useful for defining the cause and anatomic extent of perihilar obstruction. [24]" ], "bullets": [ "A negative transabdominal ultrasound does not exclude sludge or microlithiasis; consider EUS when the presentation remains biliary. [1][2][24]", "In recurrent unexplained pancreatitis with nondilated ducts, EUS, secretin-enhanced MRCP, and ERCP have all been studied as second-step tests; ERCP carries substantial morbidity when used diagnostically. [22]", "If an obstructing lesion is confirmed and therapy is needed, convert the diagnostic plan to therapeutic ERCP rather than repeating noninvasive imaging. [3][10]" ], "subsections": [], "table": null }, { "id": "erCP-procedure-risk", "eyebrow": "Procedure safety", "heading": "Risk, consent, and post-ERCP surveillance", "intro": "The threshold for ERCP should reflect both urgency of drainage and meaningful procedure-related harm.", "paragraphs": [ "Discuss ERCP adverse events when the indication is elective or uncertain. The ASGE choledocholithiasis guideline reports adverse events in 6% to 15% of ERCPs. Acute pancreatitis is the most common complication; bleeding, infection, and perforation are other major adverse events. [10][19]", "When infection risk is increased because complete biliary drainage may not be achieved, use antibiotic prophylaxis. Examples include hilar strictures and primary sclerosing cholangitis; if drainage remains incomplete after ERCP, continue antibiotics after the procedure whether or not a stent was placed. [9]", "Monitor patients after ERCP for at least 4 hours in usual practice because most post-ERCP pancreatitis becomes symptomatic within hours. Selected low-risk patients may be discharged earlier only after a minimum of 2 hours, endoscopist review, and safety-net instructions. [4]" ], "bullets": [ "Document the therapeutic objective before cannulation: drainage, stone extraction, or stenting. [3][10]", "If complete drainage is uncertain, administer antibiotic prophylaxis and continue antibiotics when post-procedure drainage is incomplete. [9]", "Assess post-procedure abdominal pain and clinical deterioration during recovery; extend observation when symptoms, sedation recovery, or procedural complexity require it. [4]" ], "subsections": [], "table": { "caption": "ERCP safety actions linked to procedural findings. [4][9][10][19]", "columns": [ "Situation", "Action", "Rationale" ], "rows": [ [ "Therapeutic probability is low", "Use EUS or MRCP before ERCP. [10][23][24]", "ERCP adverse events occur in 6% to 15%. [10]" ], [ "Known or suspected obstruction with possible incomplete drainage", "Give antibiotic prophylaxis. [9]", "Incomplete drainage increases post-ERCP cholangitis risk. [9]" ], [ "Drainage remains incomplete", "Continue antibiotics after ERCP. [9]", "Persistent obstructed biliary segments remain susceptible to infection. [9]" ], [ "Post-ERCP recovery", "Observe for at least 4 hours; selected low-risk patients require at least 2 hours plus endoscopist review before discharge. [4]", "Most post-ERCP pancreatitis becomes symptomatic within several hours. [4]" ] ] } }, { "id": "recurrent-pancreatitis", "eyebrow": "Recurrent disease", "heading": "ERCP in recurrent acute pancreatitis", "intro": "Recurrent attacks warrant etiologic definition before endoscopic treatment.", "paragraphs": [ "In recurrent acute pancreatitis without a cause after standard evaluation, pursue EUS and/or secretin-enhanced MRCP to identify a correctable biliary or pancreatic abnormality. EUS can identify duct stones or sludge, chronic pancreatitis features, pancreatic masses, and pancreas divisum; a dominant dorsal duct without communication between dorsal and ventral ducts supports pancreas divisum on EUS. [2]", "Treat a demonstrated biliary cause rather than labeling the episode idiopathic. Biliary sludge and microlithiasis can be associated with recurrent pancreatitis and may account for a portion of otherwise idiopathic cases; management in an EUS study was tailored with cholecystectomy for surgical causes or ERCP with sphincterotomy or stone extraction for endoscopically treatable disease. [1][2]", "Avoid diagnostic ERCP, bile aspiration for crystals, and sphincter of Oddi manometry as routine early testing in unexplained recurrent pancreatitis because invasive evaluation can expose patients to substantial morbidity. [22]" ], "bullets": [ "Use EUS when microlithiasis or occult choledocholithiasis is suspected after unrevealing first-line evaluation. [1][2][24]", "Use secretin-enhanced MRCP or EUS to evaluate ductal anatomy in recurrent unexplained pancreatitis with nondilated ducts. [22]", "Reserve ERCP for an endoscopic therapeutic target rather than diagnostic exploration. [10][22][24]" ], "subsections": [], "table": null } ], "faq": [], "references": [ { "number": 1, "title": "Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis | Gut", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/72/10/1919", "authors": "gut.bmj.com", "host": "gut.bmj.com" }, { "number": 2, "title": "Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis | BMJ Open Gastroenterology", "detail": "bmjopengastro.bmj.com", "url": "https://bmjopengastro.bmj.com/content/8/1/e000538", "authors": "bmjopengastro.bmj.com", "host": "bmjopengastro.bmj.com" }, { "number": 3, "title": "United Kingdom guidelines for the management of acute pancreatitis | Gut", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/42/suppl_2/S1", "authors": "gut.bmj.com", "host": "gut.bmj.com" }, { "number": 4, "title": "British Society of Gastroenterology Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Improvement Programme: minimum service standards and good practice statements | Frontline Gastroenterology", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/15/6/445", "authors": "fg.bmj.com", "host": "fg.bmj.com" }, { "number": 5, "title": "Endoscopic Management of Acute Biliary Pancreatitis: A Meta-Analysis | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/endoscopic-management-acute-biliary-pancreatitis-meta-analysis-JG200002010000016", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 6, "title": "Increased ERCP-related adverse event from premature urgent ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-024-64644-x", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 7, "title": "ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0016510705018560", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 8, "title": "Performance of diagnostic tools for acute cholangitis in patients with suspected biliary obstruction - Sperna Weiland - 2022 - Journal of Hepato-Biliary-Pancreatic Sciences - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jhbp.1096", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 9, "title": "Acute biliary conditions", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S152169181300156X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 10, "title": "ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0016510718331626", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 11, "title": "S2724 Primary Sclerosing Cholangitis in an Adolescent Presenting with Recurrent Acute Pancreatitis", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2024/10001/s2724_primary_sclerosing_cholangitis_in_an.2725.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 12, "title": "Prophylaxis of post-ERCP pancreatitis: a practice survey - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0016510709027096", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 13, "title": "Acute pancreatitis in pregnancy: A treatment paradigm based ... : International Journal of Applied and Basic Medical Research", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijab/fulltext/2013/03020/acute_pancreatitis_in_pregnancy__a_treatment.10.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 14, "title": "Abstracts of Papers Submitted to the Joint 45th... : Pancreas", "detail": "journals.lww.com", "url": "https://journals.lww.com/pancreasjournal/fulltext/2014/11000/abstracts_of_papers_submitted_to_the_joint_45th.34.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Epidemiology and Etiology of Biliary Acute Pancreatitis - The Pancreas - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/epdf/10.1002/9781119876007.ch12", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 16, "title": "Emergency Endoscopic Retrograde Cholangiopancreatography Did ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/pancreasjournal/_layouts/15/oaks.journals/downloadpdf.aspx?an=00006676-202201000-00007", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 17, "title": "Endoscopic Management of Recurrent Acute Pancreatitis", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S1542-3565(19)30501-4/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org" }, { "number": 18, "title": "Adverse Events Associated With Endoscopic Retrograde ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(24)05657-9/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org" }, { "number": 19, "title": "Complications of Endoscopic Retrograde Cholangiopancreatography", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(25)00527-X/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org" }, { "number": 20, "title": "How to Prevent Post-Endoscopic Retrograde ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(20)30359-0/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org" }, { "number": 21, "title": "Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis - Tse, F - 2012 | Cochrane Library", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/es/cdsr/doi/10.1002/14651858.CD009779.pub2//th", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 22, "title": "Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown aetiology - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1590865809000322", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 23, "title": "The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0009926099900235", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 24, "title": "Bile Duct Dilatation - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/bile-duct-dilatation", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis | Gut", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/72/10/1919", "authors": "gut.bmj.com", "host": "gut.bmj.com", "snippet": "In line with this conflicting view both entities could cause clinically significant pain, cholangitis and pancreatitis and should be treated equally. This inconsistent expert consensus reflects the need of a unified definition of those entities. A distinction is made between acute (then no longer id", "score": 0.27384543 }, { "number": 2, "title": "Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis | BMJ Open Gastroenterology", "detail": "bmjopengastro.bmj.com", "url": "https://bmjopengastro.bmj.com/content/8/1/e000538", "authors": "bmjopengastro.bmj.com", "host": "bmjopengastro.bmj.com", "snippet": "be present inside the gallbladder or common bile duct.11 The treatment of patients was tailored according to aetiology and was recorded as a surgical procedure (cholecystectomy) or endoscopic procedure (ERCP with sphincterotomy or stone extraction). CP was diagnosed according to the conventional cri", "score": 0.5265625 }, { "number": 3, "title": "United Kingdom guidelines for the management of acute pancreatitis | Gut", "detail": "gut.bmj.com", "url": "https://gut.bmj.com/content/42/suppl_2/S1", "authors": "gut.bmj.com", "host": "gut.bmj.com", "snippet": "#### Recommendation: ERCP availability\n\nFacilities and expertise should be available to perform at any time an ERCP for common bile duct evaluation followed by sphincterotomy and stone extraction or stenting as required, particularly but not exclusively in severe gallstone pancreatitis, jaundice or ", "score": 0.7447496 }, { "number": 4, "title": "British Society of Gastroenterology Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Improvement Programme: minimum service standards and good practice statements | Frontline Gastroenterology", "detail": "fg.bmj.com", "url": "https://fg.bmj.com/content/15/6/445", "authors": "fg.bmj.com", "host": "fg.bmj.com", "snippet": "There is no universally accepted time duration for monitoring patients before discharge. Extended monitoring will result in inappropriate delays to discharge and a reduction in the proportion of cases being performed as day cases, whereas short monitoring periods will result in delayed diagnosis for", "score": 0.42048118 }, { "number": 5, "title": "Endoscopic Management of Acute Biliary Pancreatitis: A Meta-Analysis | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/endoscopic-management-acute-biliary-pancreatitis-meta-analysis-JG200002010000016", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "Endoscopic therapy (endoscopic retrograde cholangiopancreatography with biliary endoscopic sphincterotomy -- ERCP/ES) has been advocated for the management of acute biliary pancreatitis. Four randomized, controlled trials (3 in peer-reviewed publications and 1 abstract) that compared the outcome of ", "score": 0.82560414 }, { "number": 6, "title": "Increased ERCP-related adverse event from premature urgent ...", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-024-64644-x", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Article \nCAS \nPubMed \nGoogle Scholar\n\nHazem, Z. M. Acute biliary pancreatitis: Diagnosis and treatment. Saudi J. Gastroenterol. 15, 147–155 (2009).\n\nArticle \nPubMed \nPubMed Central \nGoogle Scholar\n\nMiura, F. et al. Tokyo Guidelines 2018: Initial management of acute biliary infection and flowchart fo", "score": 0.6350646 }, { "number": 7, "title": "ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0016510705018560", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Research article Practical guidelines for acute pancreatitis Pezzilli R., …, Nicoletti R.Pancreatology • Volume 10 • 2010 Show abstract_Introduction:_ The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and", "score": 0.75442725 }, { "number": 8, "title": "Performance of diagnostic tools for acute cholangitis in patients with suspected biliary obstruction - Sperna Weiland - 2022 - Journal of Hepato-Biliary-Pancreatic Sciences - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/jhbp.1096", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "We assessed the diagnostic performance of Tokyo Guidelines (TG18), Dutch Pancreatitis Study Group (DPSG) criteria, and Charcot triad relative to real-world cholangitis as the reference standard. Acute or ascending cholangitis is a bacterial infection of the biliary tract superimposed upon bile duct ", "score": 0.7368747 }, { "number": 9, "title": "Acute biliary conditions", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S152169181300156X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "The UK guidelines for the management of acute pancreatitis support urgent (within the first 72 h) ERCP in patients with suspected AGP and predicted severe pancreatitis or when cholangitis, jaundice or a dilated common bile duct is present . [...] Post-ERCP AC occurs in approximately 1% of cases. Sig", "score": 0.71829855 }, { "number": 10, "title": "ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0016510718331626", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of", "score": 0.7065353 }, { "number": 11, "title": "S2724 Primary Sclerosing Cholangitis in an Adolescent Presenting with Recurrent Acute Pancreatitis", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2024/10001/s2724_primary_sclerosing_cholangitis_in_an.2725.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Published Time: Tue, 08 Jul 2025 15:32:43 GMT Official journal of the American College of Gastroenterology | ACG * Get new issue alerts Get alerts;;) ### Secondary Logo ### Journal Logo October 2024 - Volume 119 - Issue 10S Export All Images to PowerPoint FileAdd to My Favorites Colleague's E-mail i", "score": 0.58465123 }, { "number": 12, "title": "Prophylaxis of post-ERCP pancreatitis: a practice survey - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0016510709027096", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Gastrointest Endosc\n\n### Quality assessment of ERCPEndoscopic retrograde cholangiopacreatography\n\n### Gastrointest Endosc\n\n### Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success\n\n### Gastrointest Endosc\n\n### Pure versus mixed electrosurgic", "score": 0.29778177 }, { "number": 13, "title": "Acute pancreatitis in pregnancy: A treatment paradigm based ... : International Journal of Applied and Basic Medical Research", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijab/fulltext/2013/03020/acute_pancreatitis_in_pregnancy__a_treatment.10.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Acute pancreatitis in pregnancy: A treatment paradigm based ... : International Journal of Applied and Basic Medical Research\n# Acute pancreatitis in pregnancy. Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. Acute pancreatitis (AP) is", "score": 0.48850358 }, { "number": 14, "title": "Abstracts of Papers Submitted to the Joint 45th... : Pancreas", "detail": "journals.lww.com", "url": "https://journals.lww.com/pancreasjournal/fulltext/2014/11000/abstracts_of_papers_submitted_to_the_joint_45th.34.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Background and aims: The use of self-expanding metal stent (SEMS) are used to relieve obstruction in patients with unresectable pancreaticobiliary malignancies. Endoscopic sphincterotomy (ES) is performed to decrease the post-ERCP pancreatitis (PEP) and facilitate a stent placement. But bleeding is ", "score": 0.38852578 }, { "number": 15, "title": "Epidemiology and Etiology of Biliary Acute Pancreatitis - The Pancreas - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/epdf/10.1002/9781119876007.ch12", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "## Epidemiology and Etiology of Biliary Acute Pancreatitis. Acute biliary pancreatitis (ABP) is caused by common bile duct stone impaction of or passage through the duodenal papilla. Therefore, we should determine whether a case is ABP when referring patients with acute pancreatitis. Gallstone migra", "score": 0.85797083 }, { "number": 16, "title": "Emergency Endoscopic Retrograde Cholangiopancreatography Did ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/pancreasjournal/_layouts/15/oaks.journals/downloadpdf.aspx?an=00006676-202201000-00007", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis.", "score": 0.74385756 }, { "number": 17, "title": "Endoscopic Management of Recurrent Acute Pancreatitis", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S1542-3565(19)30501-4/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "Immediate endoscopic retrograde cholangiography and pancreatography (ERCP) is indicated if the following occurs: (1) there is active ascending", "score": 0.53619206 }, { "number": 18, "title": "Adverse Events Associated With Endoscopic Retrograde ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(24)05657-9/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: methodology and review of evidence. Gastrointest", "score": 0.53050464 }, { "number": 19, "title": "Complications of Endoscopic Retrograde Cholangiopancreatography", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(25)00527-X/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "ERCP is most often complicated by acute pancreatitis, bleeding, infection, or perforation, although myriad other adverse events may occur.", "score": 0.52115494 }, { "number": 20, "title": "How to Prevent Post-Endoscopic Retrograde ...", "detail": "www.gastrojournal.org", "url": "https://www.gastrojournal.org/article/S0016-5085(20)30359-0/fulltext", "authors": "www.gastrojournal.org", "host": "www.gastrojournal.org", "snippet": "Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials (ESGE) Clinical", "score": 0.49787658 }, { "number": 21, "title": "Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis - Tse, F - 2012 | Cochrane Library", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/es/cdsr/doi/10.1002/14651858.CD009779.pub2//th", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Title: Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis - Tse, F - 2012 | Cochrane Library\nTo systematically review evidence from randomized controlled trials (RCTs) assessing the clinical effectivenes", "score": 0.85538095 }, { "number": 22, "title": "Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown aetiology - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1590865809000322", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unknown aetiology - ScienceDirect\n# Liver, Pancreas and Biliary Tract Diagnostic yield of ERCP and secretin-enhanced MRCP and EUS in patients with acute recurrent pancreatitis of unkno", "score": 0.6894943 }, { "number": 23, "title": "The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0009926099900235", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared with direct cholangiography in the detection of choledocholithiasis - ScienceDirect\n# Original paper The diagnostic accuracy of magnetic resonance cholangiopancreatography and ultrasound compared wi", "score": 0.60245985 }, { "number": 24, "title": "Bile Duct Dilatation - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/bile-duct-dilatation", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "diagnosis of pancreatic cancer, ERCP was shown to have a sensitivity of 70% versus 84% with MRCP (Fig. 33.10).51 Evaluation of perihilar biliary obstruction, the most common location for cholangiocarcinoma, with both ERCP and MRCP demonstrated each to be very effective in detecting the presence of o", "score": 0.5917474 } ], "publishedAt": "2026-09-15T18:38:15.411384+00:00", "updatedAt": "2026-09-15T18:38:15.411384+00:00", "readingMinutes": 5, "slug": "ercp-in-acute-pancreatitis" }