A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis.

Eleven patients wtih gallstone-related acute pancreatitis underwent urgent duodenoscopy and diathermy sphincterotomy; six had stones impacted at the papilla of Vater, and the remainder had stones in the bile duct. One patient had a gallstone in the pancreatic duct. Endoscopic removal of the duct stones resulted in a prompt, persistent clinical and biochemical improvement, except in one patient who had been referred from another hospital with a pseudocyst 3 weeks after the onset of illness. Pancreatography results were remarkably normal in the remaining patients. Use of emergency biliary decompression in patients with acute gallstone-related pancreatitis remains controversial, and the indications need clarification. However our results justify further evaluation of duodenoscopic sphincterotomy as an alternative to surgery.