Biliary acute pancreatitis.

Severe biliary acute pancreatitis is frequently associated with persisting bile duct stones, which has important implications with regard to management. In mild cases, cholecystectomy with operative cholangiography during the same admission is the treatment of choice. In patients with a severe attack, however, management remains controversial. There is increasing evidence to suggest that early biliary decompression with endoscopic sphincterotomy is associated with a lower morbidity and mortality than a conservative regime. In certain situations endoscopic sphincterotomy may also obviate the need to explore the common bile duct, and in high-risk patients may allow surgery to be avoided altogether.