Treatment of acute biliary pancreatitis

In 10 % of the cases, acute biliary pancratitis is severe, when systemic complications occur during the first week and/or when local complications start with the second week. Magnitude of pancreatic damage is not related with the persistence of choledocolithiasis. Severe acute biliary pancreatitis is impaired by early biliary surgery, but surgery does not increase mortality and morbidity in moderate acute biliary pancreatitis. Endoscopic retrograde cholangio-pancreatography followed, when necessary, by endoscopic sphincterotomy is not recommended in moderate acute pancreatitis. In severe acute biliary pancreatitis, prognosis is not improved by endoscopic procedures. However, in case of acute cholangitis, urgent endoscopic therapy is recommended.