Although biliary pancreatitis with retained CBD stones remains by far the most common indication for ERCP, additional potential indications for ERCP in AP patients have emerged over recent years. Patients with recurrent attacks of AP caused by pancreas divisum benefit from ERCP and minor papilla sphincterotomy, which can significantly lower the rate of recurrent attacks and improve quality of life in most cases [32]. Furthermore, ERCP should also be considered for carefully selected patients who develop late complications of an initial attack of AP, regardless of the etiology of this attack. ERCP remains a valid option for the treatment of large symptomatic pseudocysts in patients showing a communication between the main pancreatic duct and the cystic cavity [33], although the EUS‐guided approach has now become the preferred route of drainage in most cases.
Conclusions
While there is clear evidence that urgent ERCP is required for cases of AP presenting with evidence of ongoing obstruction (i.e. acute cholangitis), there is currently no clear consensus on the timing of elective interventions for persistent CBD stones. We recommend an individualized approach to each case, taking into account concomitant medical conditions and potential risk factors such as pancreatitis‐related local and systemic complications (see Figure 13.2). Local expertise, including the availability of advanced surgical and radiological techniques, is also a very important factor in deciding the best treatment modality, since a multidisciplinary approach is very important for the successful treatment of severe cases of pancreatitis.
Disclosures
Professor Guido Costamagna is a consultant for Olympus, Cook Medical, and Boston Scientific. Dr. Ivo Boškoski is a research grant holder from Apollo Endosurgery and is a consultant for Apollo Endosurgery, Cook Medical, and Boston Scientific.
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