[Arguments for a revised concept in the therapy of acute pancreatitis. On the indications for conservative, endoscopic and surgical procedures].

From January 1, 1973 to October 31, 1987 we treated 271 patients suffering from acute pancreatitis at the Department of General Surgery at the University Münster, Westphalia. 159 (58.7%) presented with stage I, 75 (27.7%) with stage II, and 39 (13.6%) with stage III disease according to the Mainz classification for acute pancreatitis. In 147 cases an endoscopic sphincterotomy (EST) was performed. At a low method-specific morbidity (5.4%) we observed a mortality rate of 0% for stage I, 8% for stage II, and 22% for stage III. Altogether, a mortality rate of 13.3% was calculated for the necrotizing forms of acute pancreatitis after EST, compared to 36.5% for a conventionally (conservative therapy, operation) treated group.