Timing of endoscopic therapy for acute bilio-pancreatic diseases: a practical overview

Matteo Rossano Buonocore; Ugo Germani; Danilo Castellani; Leonidas Petrogiannopoulos; Socrate Pallio; Matteo Piciucchi; Andrea Sbrozzi-Vanni; Angelo Zullo; Raffaele Manta

Authors Matteo Rossano Buonocore, Ugo Germani, Danilo Castellani, Leonidas Petrogiannopoulos, Socrate Pallio, Matteo Piciucchi, Andrea Sbrozzi-Vanni, Angelo Zullo, Raffaele Manta.

Abstract

Diseases of the pancreas and hepatobiliary tree often require a therapeutic approach with endoscopic retrograde cholangiopancreatography (ERCP), generally following noninvasive imaging techniques. Appropriate indications and the correct timing for urgent ERCP would benefit both patients and clinicians and allow optimal utilization of health resources. Indications for urgent (<24 h) ERCP include severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, in the absence of percutaneous drainage, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management. In patients who have severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis, early (<48-72 h) ERCP is indicated. This overview aims to provide decisional flowcharts that can be easily used for managing patients with acute bilio-pancreatic disorders when they are referred to the Emergency Department.

Keywords Cholangitis, pancreatitis, cholecystitis, biliary leak, ERCP, EUS

Ann Gastroenterol 2021; 34 (2): 125-129