ERCP in Acute Pancreatitis

ERCP plays an expanding role in both the diagnosis and therapy of acute and relapsing pancreatitis of various etiologies. Although initially used in the diagnosis and treatment of biliary disorders causing pancreatitis, endoscopic interventions are now increasingly directed towards the pancreatic sphincter and ducts as well. In certain settings, such as acute gallstone pancreatitis, the value of ERCP has been proven in randomized controlled trials. There are also data to support the role of ERCP in the treatment of acute relapsing pancreatitis due to various disorders, such as pancreas divisum and to a lesser degree sphincter of Oddi dysfunction. Other applications include the use of ERCP to treat smoldering pancreatitis and pancreatic ductal disruptions in the setting of acute and chronic pancreatitis, and most recently in the setting of evolving pancreatic necrosis. Many causes of otherwise unexplained acute recurrent pancreatitis can be found after an extensive evaluation and treated by advanced ERCP techniques. The role of ERCP in acute and especially recurrent pancreatitis should be primarily therapeutic, with diagnosis first established whenever possible by other techniques, including endoscopic ultrasound and MRCP. ERCP for the diagnosis and treatment of severe or acute relapsing pancreatitis is optimally performed in a multidisciplinary context involving primary or critical care, advanced hepatobiliary-pancreatic surgery, and interventional radiology when appropriate.