Hôpital Saint-Joseph, Département d’hépato-gastroentérologie, 26 boulevard de Louvain, 13008 Marseille
The migration of gallstones is the most common cause of acute pancreatitis. Biliary origin is retained when there is an increase in ALTs and if transparietal ultrasound reveals gallbladder stones. Endoscopic ultrasound and magnetic resonance imaging have become essential to confirm the diagnosis, transparietal ultrasound and computed tomography presenting a weak sensitivity to detect common bile duct stones. The beneficial effect of ERCP with endoscopic sphincterotomy to decompress the biliary tract is clearly established in the case of acute cholangitis concomitant with acute biliary pancreatitis. Emergency ERCP is not indicated for severe acute biliary pancreatitis without associated cholangitis. ERCP with endoscopic sphincterotomy may also play a role in persistent biliary obstruction and to prevent recurrence in patients with acute non-severe biliary pancreatitis who cannot undergo cholecystectomy during the same hospitalization.
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