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Acute biliary pancreatitis… Some mistakes to avoid Volume 26, supplement 2, Novembre 2019

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Author
Hôpital Beaujon, Service de gastroentérologie-pancréatologie, 92118 Clichy cedex
* Correspondance

The biliary origin of acute pancreatitis must be systematically evoked in front of initial elevation of transaminases. Early abdominal ultrasonography is essential in the assessment of acute pancreatitis, to search for gallbladder and/or choledoco-lithiasis. If transparietal ultrasonography is normal or non contributive, only endoscopic ultrasonography will formally eliminate the diagnosis of gallbladder lithiasis. In cholecystectomized patients, the occurrence of acute pancreatitis with abnormal liver tests is suggestive of residual or de novo biliary lithiasis, intrahepatic lithiasis, Oddi sphincter dysfunction or a parapapillary duodenal diverticulum.

Cholecystectomy is the treatment of the cause of acute biliary pancreatitis and should be proposed quickly because of the risk of recurrence of bilio-pancreatic events (including a new acute pancreatitis, cholangitis, cholecystitis, or hepatic colic). It should not be challenged simply because of advanced age. It is also indicated in patients who had a biliary endoscopic sphincterotomy. Performing ERCP with sphincterotomy in emergency does not reduce the risk of complications and death in severe acute biliary pancreatitis, it is only indicated in cases of cholangitis or dilatation of the main bile duct associated with elevated bilirubin.

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