Endoscopic treatment of acute biliary pancreatitis.

The successes of supportive management of patients with severe acute pancreatitis in recent years has evolved from our improved understanding of some of the serious consequences of pancreatic necrosis on other organ systems. When gallstone disease is identified as the cause in such patients, there has been an expectation that biliary intervention will lead to a more rapid resolution of the index attack and prevention of future pancreatitis. There is now convincing evidence, in the setting of severe gallstone-associated pancreatitis using prognostic scoring, that not only is emergency or early elective biliary surgery associated with an unacceptable morbidity and mortality but that appropriate endoscopic therapy is safe and highly effective. In populations where concomitant cholangitis is common, emergency biliary endoscopic management provides optimal therapy for all grades of pancreatitis.