[Papillotomy in acute pancreatitis: more benefits than risks].

The pathogenesis of acute pancreatitis is still unclear. OPIE's theory that obstruction of the Ampulla of Vater can be an important etiological factor in acute pancreatitis is still relevant for the ongoing discussion whether endoscopic papillotomy can improve acute pancreatitis. Patients with severe acute pancreatitis have to undergo an early ERCP for the detection of the biliary origin of the disease. In case of the detection of choledocholithiasis endoscopic papillotomy should be performed. The rate of complications and the duration of hospitalization can be significantly reduced in contrast to conservative treatment. Controlled clinical studies are necessary to answer the question if endoscopic papillotomy should be carried out in all patients with severe acute pancreatitis.