The impact of timing of endoscopic sphincterotomy (ES) in the course of acute biliary pancreatitis (ABP)

Background: ES may improve the outcome of ABP, however, the adequate timing of the procedure is not fully established. Aim: We evaluated the effect of ES, timed as an emergency, early or late procedure from the onset of the disease.

Patients and methods: In a one-year prospective study, 44 consecutive ABP patients, who underwent ES, were enrolled. According to the time elapsed from the onset of ABP, the patients were classified into three groups: 1.) emergency group (ES within 12 hours; group I; n=9), 2.) early group (ES between 12–24 hours; group II; n=23) and 3.) late group (ES after 48 hours; group III; n=12). All groups were homogenous in age, gender and severity of ABP. We considered ABP to be severe, when serum C-reactive protein level was more than 150mg/l. We compared the following inter-group variables: mortality, complication rates and the length of hospitalization. Complications were defined as the development of multiple organ failure and fluid collections requiring surgical or endoscopic intervention.

Results: No mortality could be detected in the study. The complication rate of group I, II and III were 0%, 15% and 50%, respectively (p=0.035: between group I and III). In the severe ABP subgroups, the complication rate was 0%, 16% and 100%, respectively (p=0.011: between group I and III; p=0.015: between group I and II). The length of hospitalization did not differ among groups, and ranged a mean of 10.7 to 13.3 days. In the severe APB subgroups, the length of hospitalization was 8.6, 13.5 and 22.5 days in groups I, II and III, respectively (NS).

Conclusion: In ABP, emergency and early ES lower complication rates, even in severe cases of the disease. As a trend, emergency or early ES reduce the length of hospitalization in severe ABP.