Prediction of common bile duct stones and cholangitis in acute biliary pancreatitis

Abstract

Objective:To define factors in predicting common bile duct (CBD) stones and cholangitis in patients with acute biliary pancreatitis.Method:Retrospective analysis of patients with acute biliary pancreatitis who received early (< 72 h) endoscopic retrograde cholangiopancreatography (ERCP). Data on their clinical presentation, severity of attacks, liver function on admission, ERCP findings and bile culture results were analysed.Results:Sixty‐four patients admitted with acute biliary pancreatitis were referred for early ERCP. Common bile duct stones were found in 33 patients (52%). Only five (8%) patients presented with symptoms suggestive of coexisting acute cholangitis (fever, abdominal pain and jaundice). Bile cultures were positive in 12 of 18 specimens (67%), and nine of these (75%) were associated with choledocholithiasis. Variables were entered into a logistic regression analysis and a high bilirubin level on admission was the only significant factor in predicting ductal stones.Conclusion:In the locality of Hong Kong the incidence of choledocholithiasis is high in acute biliary pancreatitis and only a high bilirubin level can predict CBD stones. Although many patients have infected bile, overt cholangitis is relatively uncommon. Chinese Abstract imageimageimageimageimage