Gallstone-induced Acute Pancreatitis Research Articles

Severity of gallstone, sludge or microlithiasis induced pancreatitis - all of the same?

Severity of microlithiasis and sludge-induced pancreatitis in comparison to gallstone-induced pancreatitis has never been studied for a lack of definition. In order to understand whether bile duct obstruction or other mechanisms contribute to biliary pancreatitis severity we performed a monocentric, retrospective cohort study. In this retrospective cohort study 263 patients with acute biliary pancreatitis treated at a tertiary care center from 2005 to 2021 were stratified according to the recent consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared to microlithiasis, sludge and suspected stone passage pancreatitis cohorts in terms of pancreatitis outcome, liver function and EUS/ERCP results using one-way ANOVA and Chi2 test. Multinomial logistic regression analysis was performed to correct for bias. Microlithiasis and sludge-induced pancreatitis classified according to the revised Atlanta classification, did not present with a milder course than gallstone-induced pancreatitis (p = 0.62). Microlithiasis and sludge showed an increase in bilirubin on the day of admission to hospital, which was not significantly different from gallstone-induced pancreatitis (p = 0.36). The likelihood of detecting biliary disease on EUS resulting in bile duct clearance was highest on the day of admission and day 1, respectively. Microlithiasis and sludge induce gallstone-equivalent impaired liver function tests and induce pancreatitis with similar severity compared with gallstone-induced acute biliary pancreatitis.

A Descriptive Study of the Demographic and Clinicopathological Characteristics of Individuals With Gallstone-Induced Pancreatitis in a Tertiary-Level Hospital in Ranchi, Jharkhand.

Gallstones are a major cause of acute pancreatitis, which is associated with high recurrence, morbidity, and mortality. Careful consideration of demographic and clinicopathological features is required to understand the association between the cause and severity of pancreatitis in various populations, and such crucial information is lacking for Jharkhand's population. Here, we sought to describe the demographic and clinicopathological features of gallstone-induced acute pancreatitis at a tertiary hospital in Ranchi. This hospital-based descriptive study was conducted at Rajendra Institute of Medical Sciences in Ranchi. The hospital records of patients admitted to the surgical unit with acute gallstone-induced pancreatitis from January 2023 to December 2023 were analyzed. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Of the 72 patients admitted with acute gallstone-induced pancreatitis (mean age: 42.5 years), 46 (64%) were males and 26 (36%) were females. All 72 patients had abdominal pain and 44 (61%) were vomiting. The severe vs. non-severe pancreatitis groups differed significantly in age (≥40) and male gender (p = 0.013 and 0.031, respectively). A total of 45 (62.5%) patients had severe gallstone-induced pancreatitis, and the most common complication was acute kidney injury, followed by pleural effusion (18 (25%) and 13 (18.1%) cases, respectively). Our study revealed that gallstone-induced pancreatitis was more common in males and that age and gender were significantly associated with severity. However, late presentation to the hospital may have influenced our study, resulting in more severe cases being reported, with the most common complication being acute kidney injury. To our knowledge, this is the first study to describe the demographic, clinicopathological, and outcome data of acute gallstone-induced pancreatitis in Ranchi. These results can guide hospital policy development to improve patient outcomes.

Biliary sludge, microlithiasis and gallstone-induced acute pancreatitis are associated with comparable clinical outcome: a single-centre analysis and narrative review of the literature

Biliary sludge, microlithiasis and gallstone-induced acute pancreatitis are associated with comparable clinical outcome: a single-centre analysis and narrative review of the literature

Acute Pancreatitis In Type 2 Diabetes Mellitus With Multiple Stones In The Cystic Ductus

<p><strong>Introduction:</strong> Severe upper abdominal pain is one of the symptoms of acute pancreatitis that often occurs in other diseases, such as peptic ulcer, acute hepatitis, cholangitis, and cholecystitis. Gallstone-induced acute pancreatitis has considerable morbidity and mortality.</p><p><strong>Case illustration:</strong> A 50-year-old man came to the ED with a chief complaint of severe abdominal pain in the upper abdomen, VAS 8-9. His past medical history was unknown. On arrival, blood pressure was 141/102 mmHg, pulse was 98x/minute, and temperature was 36.4ºC. CT Scan of the abdomen showed pancreatitis and multiple stones in the cystic duct. Amylase and lipase serum results were 1897U/L and >3000 U/L.</p><p><strong>Discussion:</strong> In acute pancreatitis caused by gallstones, stones usually get stuck in the branches of the pancreaticobiliary duct. Obstruction at this location causes reflux of bile into the pancreatic duct. Smaller gallstones are more likely to induce pancreatitis because they migrate more easily between bile ducts. This patient was suspected of having a previously unknown history of DM, which contributed to the patient's worsening condition.</p><p><strong>Conclusion:</strong> Early management and treatment of triage, fluid resuscitation, and detection of local or systemic complications are essential. In pancreatitis due to gallstones, decisions about the need and timing of procedural intervention are critical. </p>

Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone-induced acute cholangitis and pancreatitis.

Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.

Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Acute Pancreatitis: Diagnosis

There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) epigastric or upper abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on abdominal images such as ultrasonography, computed tomography (CT) or magnetic resonance imaging. Other pancreatic diseases and acute abdomen have been ruled out before making a diagnosis of acute pancreatitis. Serum lipase may be more useful than serum amylase because serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Contrast-enhanced CT scan is the best imaging technique to rule out the conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis. The etiology of acute pancreatitis should be made clear as soon as possible to decide treatment policy of acute pancreatitis or to prevent the recurrence of pancreatitis. The etiology of acute pancreatitis in an emergency situation should be assessed by clinical history, laboratory tests such as serum liver function tests, measurement of serum calcium and serum triglycerides and ultrasonography. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because early endoscopic retrograde cholangiopancreatography should be considered if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected.

Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study.

Objectives:To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis.Methods:Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition.Results:A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay.Conclusion:Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.

A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Comparison of Ranson’s and Glasgow criteria with revised Atlanta in prediction of mortality in acute pancreatitis patients

Background: To compare the performance of Ranson’s Score (RS) and Glasgow Score (GS) with Revised Atlanta Classification (RAC) in prediction of mortality, and to check their suitability to replace RAC for surgical intervention of gallstone induced acute pancreatitis (GAP).Methods: A hospital based prospective study was conducted between April 2014 and May 2017 with patients presenting with GAP. RS and GS was evaluated using data in first 24 hours and at 48 hours post admission. Patients were classified into mild, moderate and severe based on RAC at the time of hospital stay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scoring system. Receiver Operating Characteristics (ROC) curves for mortality, ICU admission, Organ Failure (OF) and Gallstone Recurrence (GR) were plotted and predictive accuracy of each scoring system was measured by the Area under Curve (AUC). AUC values were compared for statistical significance using De Long test. A p-value of &lt;0.05 was considered statistically significant.Results: Of 81 patients, 15 patients had OF and local complication classified as SAP, with persistent OF (16.0%). The AUC for RS was consistently the highest for predicting mortality (0.943), recurrence of gallstone (0.766), ICU-admission (0.801) and OF (0.852). RS had high specificity (61.9%), PPV (88.2%), Accuracy (90.1%) for predicting mortality, recurrence of gallstone and OF. Glasgow criteria had high sensitivity (85.1%), NPV (79.4) in predicting ICU-admission.Conclusions: RS in comparable with RAC in predicting mortality, GR in patients with GAP and early referral for surgical intervention.

Ectopic Liver Tissue on the Gallbladder: a Rare Incidental Finding

Ectopic liver is a rare developmental anomaly that most commonly is incidentally detected in the abdomen, with the gallbladder being the most common site during laparoscopic surgery. Although the natural course of the ectopic liver is unpredictable, rarely they can become symptomatic due to torsion, necrosis, rupture, pyloric obstruction, and malignant transformation. Here, we report an interesting image of an ectopic liver on the gallbladder with its own vascular supply, detected during laparoscopic cholecystectomy in a patient with gallstone-induced acute pancreatitis.

Serotonin, calcitonin and calcitonin gene-related peptide in acute pancreatitis

Objective: The aim of this study was to investigate plasma levels of serotonin, calcitonin and calcitonin gene-related peptide (CGRP) in the course of acute pancreatitis (AP) taking organ failure, etiology and severity into consideration.Material and methods: Sixty consecutive patients with alcohol- or gallstone-induced AP were included over a 15-month period. Patients were treated according to a standardized algorithm and monitored for organ specific morbidity and mortality. Organ functions and blood samples were assessed on days 0, 1, 2 and 14 after hospital admission. Twenty healthy volunteers, matched for age and gender, comprised the reference group.Results: Lower levels of serotonin were observed in patients at admission compared to healthy volunteers (p = .021). Serotonin levels increased from day 2 to 14 (p < .001), but with no relation to severity, etiology or organ failure. No difference in calcitonin levels was found in patients at admission compared to healthy volunteers. However, calcitonin levels decreased over time (p < .001) and higher levels were found in patients with respiratory failure (p = .039). No difference was observed in relation to severity or etiology. CGRP levels in patients at admission did not differ from healthy volunteers, nor did CGRP change over time or show any relationship to severity, etiology or organ failure.Conclusion: Our data suggest serotonin and calcitonin levels to be associated to time-course of AP, and calcitonin levels to organ dysfunction. We hypothesize that serotonin plays a pathogenic role in the compromised pancreatic microcirculation, and calcitonin a role as a biomarker of severity in AP.

Analysis of Factors Associated with the Severity of Acute Pancreatitis according to Etiology.

Background The objective of this study was to determine the factors associated with severity of acute pancreatitis (AP) according to two major etiologies: alcohol and gallstones. Methods We reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. A total of 905 patients with AP (660 alcohol-induced, 245 gallstone-induced) were enrolled. Among them, severe AP (SAP) occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Contributing factors between patients with and without SAP were analyzed according to the etiology. Results Multivariate analysis demonstrated that current smoking, pancreatic necrosis, and bacteremia were associated with AP severity in both alcohol- and gallstone-induced AP. Pancreatic fluid collection was significantly associated with alcohol-induced SAP (p = 0.04), whereas dyslipidemia was significantly associated with gallstone-induced SAP (p = 0.01). Body mass index was significantly correlated with the Bedside Index of Severity in Acute Pancreatitis score in both alcohol- and gallstone-induced AP (p = 0.03 and 0.01, resp.). Conclusions Current smoking, pancreatic necrosis, and bacteremia can aggravate the clinical course of AP. Pancreatic fluid collection and dyslipidemia were associated with AP severity according to the different etiologies. Obesity may also be associated with AP severity in both etiologies.

Comparative evaluation of early laparoscopic cholecystectomy for mild gallstone pancreatitis vs acute cholecystitis

Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis (AC) is now an established procedure, but timing for LC in gallstone-induced acute biliary pancreatitis (ABP) is still controversial. Interval cholecystectomy is justified in cases of severe pancreatitis, however, in patients with mild disease, which constitute the majority (80%) of the cases, patients can safely be operated during the index admission. The profile of patients with mild gallstone pancreatitis and AC appears to be similar, since both are complications of gallstone disease. The LC in both situations is equally challenging, due to risk of inflammation and adhesions. However, both conditions are likely to benefit from early LC, in terms of rapid recovery and shortened hospital stay. But no author has compared the outcome of LC in these two similar clinical entities in the past. Hence the present study compares the outcome of LC in case of mild ABP versus AC. This prospective study was conducted on 77 patients undergoing LC for AC with or without pancreatitis, during index admission. Cases were divided into two groups of mild ABP (n=25) and AC (n=52). Both groups were compared with respect to the clinical presentation, timing of cholecystectomy, operative findings, duration of surgery, difficulty in dissection, intra-operative or postoperative complications, duration of hospital stay and outcome at time of discharge. The majority of patients in both groups underwent successful LC. Both groups were comparable, with respect to demographic profile, mean duration of surgery, gallbladder adhesions (32% vs 29%), thickened edematous gallbladder (76% vs 71%), difficult dissection (32% vs 29%) and need of conversion to open procedure (16% vs 17%). Both groups were also comparable, with respect to intra-operative complications (8% vs 10%). Post operative recovery was prolonged in case of ABP, in comparison to AC, but was not significant statistically (p >0.05). Total post-operative complications were significantly more in ABP group (p <0.01). Post operative stay (mean days 2.76 vs 2.34), as well as total hospital stay (mean days 7.24 vs 5.15) was significantly prolonged in cases with ABP (p <0.05). LC can be safely performed during index admission in patients with mild ABP as can be done in cases of AC.

New hormones to predict the severity of gallstone-induced acute pancreatitis.

Levels of the hormones ghrelin and leptin in rat models of acute pancreatitis (AP) have been investigated in several experimental studies. However, there are very few clinical studies addressing the connection between hormone levels and AP. A few recent studies investigating the changes in ghrelin and leptin levels in patients with AP have been reported; however, our study is the first clinical study to investigate the change of nesfatin-1 levels in patients with gallstone-induced AP. Forty patients were enrolled in this study, eight of which presented with severe AP. Two blood samples were obtained from each study patient. The first blood samples were obtained at patient admission to the hospital and the second was obtained at patient discharge. All samples were collected after at least 6 h of fasting. Plasma nesfatin-1, leptin, and ghrelin levels were measured. In all 40 patients, nesfatin-1 and leptin levels were higher at admission and had decreased at discharge. In contrast, the ghrelin levels at discharge were significantly higher than those at admission. Only the changes in these hormones in the mild AP group were significant. Levels of these hormones were altered during the course of gallstone-induced AP. These changes might be associated with the clinical outcomes of the disease. To clarify whether the magnitude of the change in hormone levels at AP onset can be used as a biomarkers to predict the severity of the disease requires further investigation.

Statin Use in Patients With Acute Pancreatitis and Symptomatic Gallstone Disease

The long-term use of statins may be associated with a decreased risk for gallstones and biliary-induced acute pancreatitis (AP). Our aim was to study the relationship of statin use and outcome of AP. We investigated the records of 461 consecutive patients with AP and 1140 patients with symptomatic gallstones during 2008 to 2010. The use of lipid-lowering drugs, patient's characteristics, and outcome of patients were recorded. All known risk factors for AP and particularly statin use in idiopathic AP were analyzed. Statin use was comparable between the patients with AP (22%) and patients with cholelithiasis (24%). The frequencies of surgical treatment, duration of hospital stay, or mortality were not different between the statin users compared with the nonusers. Idiopathic AP was more often associated with the use of statins than alcohol- or gallstone-induced AP (44% vs 30% vs 13%, P < 0.002). The etiology of AP was alcohol in 56% of the patients, gallstones in 28% of the patients, and unknown (idiopathic) or miscellaneous in 16% of the patients. No beneficial effect of statins was observed in mortality or other outcome parameters of patients with AP. Statin use was more frequent in patients with idiopathic AP than in patients with biliary- or alcohol-induced AP.

Activity of neutrophil elastase reflects the progression of acute pancreatitis

Objective. Neutrophil elastase (NE) concentration is associated with progression of acute pancreatitis (AP), but measuring total NE concentration includes biologically inactive NE. This study aims to investigate the relationship between NE activity and the aetiology and severity of AP and associated organ failure. Methods. Seventy-five patients admitted to our surgery department with a first episode of AP during 2004–2005 were age- and sex-matched to 20 healthy volunteers (controls). NE activity was assessed using venous blood samples obtained on patient admission and after 1, 2 and 14 days. One sample was also taken from each control. ANOVA was used for statistical comparison between groups. Results. Baseline NE activity (geometric mean; 95% confidence intervals) differed between patients (58.6 nM of substrate 7-amino-4-methylcoumarin [AMC]/hour; 48.52–70.72) and controls (31.5 nM AMC/hour; 25.5–39.0) (p = 0.0003), and did not correlate with time between symptom onset and admission. Patients with alcohol-induced AP demonstrated higher mean activity (59.1 nM AMC/h; 44.7–78.2) than those with gallstone-induced AP (41.7 nM AMC/h; 33.9–51.4) (p = 0.0496). NE activity was higher overall in patients with predicted severe AP (60.9 nM AMC/h; 48.0–77.2) than in those with predicted mild AP (42.1 nM AMC/h; 34.9–50.8) (p = 0.027). Patients with respiratory failure had higher NE activity (82.5 nM AMC/h; 57.5–118.4) than those without (43.9 nM AMC/h; 37.6–51.3) (p = 0.0024). Conclusions. NE activity was associated with predicted severity of AP and AP-associated respiratory failure. Specific NE inhibitors may have therapeutic potential in acute pancreatitis.

Survey of the management of acute pancreatitis in surgical departments in Sweden

Objective. Several international guidelines concerning the treatment of acute pancreatitis has been published during the last decades. However, Scandinavian guidelines are still lacking. The aim of the present study is to identify current treatment strategies for acute pancreatitis in Sweden and to evaluate if there is a need for improvement and the role of guidelines. Material and methods. A questionnaire was e-mailed to the surgical departments at all Swedish hospitals (n = 58) managing patients with acute pancreatitis. Comparisons were made both between university and non-university hospitals, and between hospitals with more versus less than 150,000 persons in the primary catchment population. Results. Fifty-one hospitals responded (88%). In median, 65 (12–200) patients with acute pancreatitis are treated yearly at each hospital. Of 51 hospitals, 18 perform a severity classification, with APACHE II being the most commonly used. A majority are of the opinion that a scoring system is not better than the judgment of a senior consultant. In severe acute pancreatitis, 29/48 routinely administer antibiotics, 29/48 use enteral nutrition, and 25/49 have a standardized follow-up plan. The majority considered administration of intravenous fluids as the most important treatment in severe acute pancreatitis. After mild gallstone-induced acute pancreatitis, the corresponding response was cholecystectomy, especially at larger hospitals (p = 0.002). Of 47, 42 are interested in developing a Scandinavian quality register. Conclusions.The results from this first Swedish national survey provide an insight into current traditions of treatment of acute pancreatitis and points, for example, at the lack of early severity stratification. A majority of hospitals are interested in developing a quality register in acute pancreatitis.

Mannan-Binding Lectin and Mannan-Binding Lectin-Associated Serine Protease 2 in Acute Pancreatitis

Complement activation may play a prominent role in acute pancreatitis (AP). Mannan-binding lectin (MBL) and MBL-associated serine protease 2 (MASP-2) participate in complement activation. The objective of the present study was to evaluate the role of MBL and MASP-2 as markers in AP with regard to etiology, inflammatory activity, severity, and development of multiorgan failure. Sixty patients with AP were included. All patients were diagnosed and treated according to a standardized regimen. Blood samples were obtained immediately on admission and again on days 1, 2, and 14. Both MBL (P < 0.001) and MASP-2 (P = 0.002) levels changed significantly over time, but without any significant relation to severity, multiorgan failure, or mortality. We found significantly higher levels of MBL (P = 0.04) in alcohol- than in gallstone-induced AP, but no significant difference in MASP-2 levels. The MBL and MASP-2 acted as acute-phase reactants, but overall, they were not markers for severity, multiorgan failure, nor for mortality in AP. Our results suggest that MBL and MASP-2 play only a minor role in the inflammatory response in AP.

Acute pancreatitis in the elderly - Can we perform better?

Background Despite age traditionally being a criterion for stratification of severity in acute pancreatitis (AP), the condition is not common in the elderly population (>80 years) and very few studies have examined outcome in this cohort. The aim of this study was to evaluate our experience and outcome in this expanding population. Methods A retrospective analysis was performed of all patients over 80 years of age who were admitted with AP (defined as a serum amylase >400 IU/L) between January 2004 and January 2007. The modified Glasgow score was used for severity stratification. Results Forty patients with AP were admitted during the study period, of whom 23 were females. The mean age was 84 (SD 4.1) years. Fifteen patients (37%) had severe AP as indicated by a Glasgow score of 3 or more. The aetiologies were gallstones ( n = 28; 70%), drug-induced ( n = 4; 10%) and idiopathic ( n = 8; 20%). Ten patients (25%) died during their initial admission to hospital, of whom 5 died before undergoing any form of imaging to determine the cause of AP. Six patients, 5 of whom had gallstones were subsequently readmitted with a further attack of AP. Eleven patients underwent an ERCP during their initial admission and a further 4 patients underwent ERCP during their subsequent admission. Only 3 patients with gallstone-induced AP underwent a cholecystectomy, all performed laparoscopically. Conclusions AP in octogenarians is a significant problem and carries a high mortality irrespective of the Glasgow severity score. Early intervention by means of ERCP is indicated to try and improve outcome in this group with biliary pancreatitis. Laparoscopic cholecystectomy must be considered as a definitive treatment in these patients as available evidence suggests that this can be performed with acceptable morbidity and mortality in this group.

Gallstone‐induced acute pancreatitis

In the care of acute pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced acute pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced acute pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced acute pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.