Severe Acute Biliary Pancreatitis Research Articles

The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study

BackgroundThere is lack of data on the association between socioeconomic factors, guidelines compliance and clinical outcomes among patients with acute biliary pancreatitis (ABP). MethodsPost-hoc analysis of the international MANCTRA-1 registry evaluating the impact of regional disparities as indicated by the Human Development Index (HDI), and guideline compliance on ABP clinical outcomes. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission. ResultsAmong 5313 individuals from 151 centres across 42 countries marked disparities in comorbid conditions, ABP severity, and medical procedure usage were observed. Patients from lower HDI countries had higher guideline non-compliance (p < 0.001) and mortality (5.0% vs. 3.2%, p = 0.019) in comparison with very high HDI countries. On adjusted analysis, ASA score (OR 1.810, p = 0.037), severe ABP (OR 2.735, p < 0.001), infected necrosis (OR 2.225, p = 0.006), organ failure (OR 4.511, p = 0.001) and guideline non-compliance (OR 2.554, p = 0.002 and OR 2.178, p = 0.015) were associated with increased mortality. HDI was a critical socio-economic factor affecting both mortality (OR 2.452, p = 0.007) and readmission (OR 1.542, p = 0.046). ConclusionThese data highlight the importance of collaborative research to characterise challenges and disparities in global ABP management. Less developed regions with lower HDI scores showed lower adherence to clinical guidelines and higher rates of mortality and recurrence.

Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis

BackgroundAntibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP).Materials and methodsClinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset.ResultsA total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP.ConclusionStrategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.

Traditional Chinese medicine nursing rounds based on integration of medical care model for a patient with severe acute biliary pancreatitis

Traditional Chinese medicine nursing rounds based on integration of medical care model for a patient with severe acute biliary pancreatitis

Endoscopic retrograde cholangiopancreatography in severe acute biliary pancreatitis: there is no point in running!

Endoscopic retrograde cholangiopancreatography in severe acute biliary pancreatitis: there is no point in running!

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue. To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP. This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023. Mortality and morbidity after EC. Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P < .001) and morbidity (7.7% vs 3.7%, P < .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P < .001), morbidity (30 [30.3%] vs 57 [5.5%], P < .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P < .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P < .001), morbidity (30 [30.3%] vs 17 [10.3%], P < .001), and infections (12 [14.6%] vs 2 [1.3%], P < .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient's age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003). This cohort study's findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC.

Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): a multicentre prospective study

ObjectiveRoutine urgent endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic biliary sphincterotomy (ES) does not improve outcome in patients with predicted severe acute biliary pancreatitis. Improved patient selection for ERCP by means...

ОПЫТ ЛЕЧЕНИЯ ОСТРОГО ПАНКРЕАТИТА БИЛИАРНОЙ ЭТИОЛОГИИ

The general characteristics of the methods and results of the treatment of acute pancreatitis of biliary etiology for the period from January 1, 2012 to December 31, 2021 are presented. Patients with acute biliary pancreatitis are cared for based on the key principles of acute pancreatitis treatment of any other etiology – the long-term multicomponent intensive therapy aimed to relieve the syndrome of the systemic inflammatory response, to prevent multiple organ failure and infection of pancreatic necrosis foci, to refuse direct surgical interventions at the early stage of the disease, the reasonable use of minimally invasive draining interventions and the use of a regimen of repeated programmed operations to actively control all areas of necrotic destruction and infection to prevent the development of intra-abdominal complications. Currently the key component of complex treatment of acute pancreatitis of biliary etiology is unanimously considered as the relief (conservative or surgical) of pancreatobiliary ductal hypertension. Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically substantiated method of choosing the final treatment for acute biliary pancreatitis and should be performed regardless of the severity of the disease during the current hospitalization in all patients, as soon as their condition allows them to transfer the intervention. Early laparoscopic cholecystectomy with choledochal drainage according to Halsted is a pathogenetically grounded method of choice of the definitive treatment of acute biliary pancreatitis etiology and should be carried out regardless of the disease severity in the period of the current hospitalization for all patients as soon as their state allows to survive the intervention. Lethal outcomes at moderately severe and severe acute biliary pancreatitis are almost evenly distributed according to the terms (till/later than 2 weeks) after the disease beginning; their main cause is progressing multiple organ failure both in the aseptic course of the disease and at pancreatic necrosis infection.

Therapeutic outcomes of early and delayed ERCP and PTCD in patients with obstructive severe acute biliary pancreatitis

Therapeutic outcomes of early and delayed ERCP and PTCD in patients with obstructive severe acute biliary pancreatitis

Optimal Timing and Outcomes of Minimally Invasive Approach in Acute Biliary Pancreatitis.

BackgroundWe analyzed the outcomes of early biliary decompression by a minimally invasive approach in acute biliary pancreatitis (ABP).Material/MethodA retrospective study was conducted on 143 patients with ABP who underwent biliary decompression by laparoscopic or endoscopic approach between January 2015 and March 2022. Data from the observation sheets and surgical protocols were analyzed in terms of demographic characteristics, clinical and paraclinical features at admission, comorbidities, therapeutic management, and outcomes.ResultsThe mean patient age was 62.3±11.4 years. Mild ABP had a higher frequency in men (75.5%) and urban areas (70.4%). The comorbidities associated with a higher risk of severe forms were diabetes mellitus (odds ratio [OR]: 11.250), chronic bronchopneumopathy (OR: 29.297), and ischemic coronary disease (OR: 2.784). The mean hospital stay was 7.6±3.8 days and was significantly higher in severe forms (10±2.4 days, P<0.001). The time from onset to presentation was significantly higher in severe vs mild forms (5.6 vs 1.8 days, P<0.001) and was associated with systemic and local complications. Creatinine over 2 mg/dL (OR: 4.821) and leukocytes >15 000/mmc at admission (OR: 3.533) were risk factors for systemic complications, while obesity was associated with increased local complications (OR: 5.179). None of the patients with an early presentation developed severe ABP.ConclusionsEarly biliary decompression, as soon as possible after onset, either by an endoscopic or minimally invasive approach, is a safe and effective procedure in ABP. The type of procedure and optimal timing should be individualized, according to the patient’s local and general features.

Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta-Analysis.

Recommendations regarding the timing of cholecystectomy for acute biliary pancreatitis (ABP) require a systematic summary of current evidence to guide clinical practice. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing early cholecystectomy (EC) versus delayed cholecystectomy (DC) in patients with ABP. We searched databases Medline, Embase, SCOPUS, Web of Science and Cochrane CENTRAL for randomized controlled trials addressing this question. Pairs of reviewers abstracted data and assessed the risk of bias in included studies. A random-effects meta-analysis was done to study the effect of the timing of cholecystectomy on outcomes of interest in patients with ABP. GRADE methodology was used to rate the quality in the body of evidence for each outcome as high, moderate, low, or very low. 11 randomized trials (1176 participants) were included. High-quality evidence from seven RCTs (867 participants) showed a statistically significant reduction in the risk for recurrent biliary events in favour of early cholecystectomy (RR 0.10, 95% CI 0.05 to 0.19, I2 = 0%). High-quality evidence from five trials was in favour of early cholecystectomy with a significant reduction in the risk 7of recurrent pancreatitis (RAP) in comparison to delayed cholecystectomy (RR 0.21, 95% CI 0.09 to 0.51, I2 = 0%). This review showed that EC has definite advantages over DC in terms of reducing recurrent pancreaticobiliary events and LOS following mild ABP. However, more RCTs are required to study the role of EC in patients with moderately-severe and severe ABP. Trial Registration Protocol registered on Prospero (CRD42020192823).

Оптимизация хирургического лечения острого деструктивного панкреатита

Objective. To improve the results of endovideosurgical treatment of patients with acute destructive pancreatitis. Material and methods. The research was carried out at the bases of the Nur-Sultan Multifunctional City Hospital №2 and the Nur-Sultan Multifunctional City Hospital №1. Statistical analysis of the results was carried out using the methods of variation statistics with the calculation of M ± SD. Differences between comparison groups were analyzed using the Wilcoxon-Man-Whitney test and were considered statistically significant at p≤ 0.05. From 2017-2021, 64 patients with acute destructive pancreatitis were treated according to the developed and implemented treatment algorithm: Of these: AP without organ failure and local or systemic complications -10 people. AP of moderate and severe form -54 people. Lethal outcomes-1; The average length of stay in the hospital is 20.8±1.2 days; The mean age was 43 ± 1.3 years. The control group - treatment of patients with moderate and severe acute biliary pancreatitis without the use of ulinostatin (hereinafter US) was n = 122; Lethal outcomes-8. An algorithm for the use of US was developed and implemented depending on the severity of the course of destructive pancreatitis in the complex treatment of patients with AP. Results. 10 patients were treated conservatively. 54 - surgical treatment was combined with the appointment of US according to the developed scheme. Endoscopic surgery was performed in 51 patients; 3 patients were operated on by laparotomy. The average duration of hospital stay in the main group was 3.5±0.34 days less than in the control group. Conclusion. The research results showed the high efficiency of the developed algorithm for endovideosurgical treatment of AP in combination with the use of the US. Received AC №14704 dated January 27, 2021 (www.kazpatent.kz).

Single-stage and two-stage approaches in the management of acute biliary pancreatitis: indications and contraindications

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 133 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2021 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

Utility of Neutrophil to Lymphocyte ratio and platelet to lymphocyte ratio as early predicter of severe acute biliary pancreatitis

Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring systems have been used to predict severe acute pancreatitis which are either time-consuming or calculated 48 hours after admission. This study was aimed to assess the utility of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio as an early predictor of severe acute biliary pancreatitis.Materials and Methods: This was a retrospective cohort study conducted from January 2017 to January 2020. Patients with non-biliary pancreatitis, referred after initial treatment, missed data, and acute pancreatitis with acute cholecystitis or cholangitis were excluded from the study. Data were collected from case sheets. Patients were divided into two groups according to the development of severe acute biliary pancreatitis based on the revised Atlanta Classification. Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with severe acute biliary pancreatitis was assessed using Mann Whitney U-test. p-value &lt; 0.05 was considered as statistically significant.Results: Total 73 cases included in the study (males/females= 0.55). Sixty-six patients (90.4%) had mild/moderate acute biliary pancreatitis, and 7 (9.6%) patients had severe acute biliary pancreatitis. There was a development of complications in 7 (9.6%) patients who had severe acute biliary pancreatitis including one mortality. The mean neutrophil to lymphocyte ratio and mean platelet to lymphocyte ratio were high in the severe acute biliary pancreatitis group compared to the nonsevere acute biliary pancreatitis group, however, these differences were not statistically significant.Conclusions: Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio cannot predict severe acute biliary pancreatitis.

Surgical treatment of acute biliary pancreatitis

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

Open Abdomen Treatment in Acute Pancreatitis.

Background: Severe acute pancreatitis (SAP) is a heterogeneous and life-threatening disease. While recent guidelines recommend a stepwise approach starting with non-surgical techniques, emergency laparotomy remains inevitable in certain situations. Open abdomen treatment (OAT) may follow, potentially resulting in additional risks for severe morbidity. Causative factors and clinical impact of OAT in SAP are poorly understood and therefore issue of the present study.Materials and Methods: A retrospective analysis of patients admitted to the Department of General, Visceral, Thoracic and Vascular Surgery at University of Bonn suffering from acute pancreatitis (ICD K.85) between 2005 and 2020 was performed. Medical records were screened for demographic, clinical and outcome parameters. Patients who received primary fascial closure (PFC) were compared to those patients requiring OAT. SAP-specific scores were calculated, and data statistically analyzed (P = 0.05).Results: Among 430 patients included, 54 patients (13%) had to undergo emergency laparotomy for SAP. Patients were dominantly male (72%) with a median age of 51 years. Indications for surgery were infected necrosis (40%), suspected bowel perforation (7%), abdominal compartment syndrome (5%), and acute intra-abdominal hemorrhage (3%). While 22 patients (40%) had PFC within initial surgery, 33 patients (60%) required OAT including a median of 12 subsequent operations (SD: 6, range: 1–24). Compared to patients with PFC, patients in the OAT group had significantly fewer biliary SAP (P = 0.031), higher preoperative leukocyte counts (P = 0.017), higher rates of colon resections (P = 0.048), prolonged ICU stays (P = 0.0001), and higher morbidity according to Clavien–Dindo Classification (P = 0.002). Additionally, BISAP score correlated positively with the number of days spent at ICU and morbidity (P = 0.001 and P = 0.000002). Both groups had equal mortality rates.Discussion: Our data suggest that preoperative factors in surgically treated SAP may indicate the need for OAT. The procedure itself appears safe with equal hospitalization days and mortality rates compared to patients with PFC. However, OAT may significantly increase morbidity through longer ICU stays and more bowel resections. Thus, minimally invasive options should be promoted for an uncomplicated and rapid recovery in this severe disease. Emergency laparotomy will remain ultima ratio in SAP while patient selection seems to be crucial for improved clinical outcomes.

Timing of endoscopic therapy for acute bilio-pancreatic diseases: a practical overview

Diseases of the pancreas and hepatobiliary tree often require a therapeutic approach with endoscopic retrograde cholangiopancreatography (ERCP), generally following noninvasive imaging techniques. Appropriate indications and the correct timing for urgent ERCP would benefit both patients and clinicians and allow optimal utilization of health resources. Indications for urgent (<24 h) ERCP include severe acute cholangitis, acute biliary pancreatitis with cholangitis, biliary or pancreatic leaks, in the absence of percutaneous drainage, and severe acute cholecystitis in patients who are unfit for surgery and do not respond to conservative management. In patients who have severe acute biliary pancreatitis with ongoing biliary obstruction but without cholangitis, early (<48-72 h) ERCP is indicated. This overview aims to provide decisional flowcharts that can be easily used for managing patients with acute bilio-pancreatic disorders when they are referred to the Emergency Department.

Incidentally Detected Residual Gallbladder Calculi by Computed Tomography in Acute Pancreatitis. Case Report

Calculi in the gallbladder or cystic duct remnant account for 0.3 to 2.5% of cases of post-cholecystectomy syndrome and must be considered in any patient who has undergone “difficult” cholecystectomy. We present an interesting case of a 62-year-old male, diagnosed to have moderately severe acute biliary pancreatitis, 4 years past laparoscopic converted to open cholecystectomy (LCOC). On evaluation with contrast computed tomography (CT) of the abdomen, changes of acute pancreatitis, along with a remnant gallbladder containing radiopaque calculi, were identified. The patient subsequently was managed successfully with completion cholecystectomy with common bile duct (CBD) exploration and T-tube drainage (for CBD calculi). Hence, differential diagnosis of residual gallbladder calculi (although rare) should be kept in a patient with acute biliary pancreatitis, following LCOC for a “difficult” gallbladder.

Drenaje guiado por ultrasonido endoscópico con stent metálico de aposición luminal y necrosectomía endoscópica directa para el tratamiento de la necrosis pancreática infectada

Walled-off necrosis (WON) is a serious complication of acute pancreatitis (AP) and, when is infected, has a poor prognosis and mortality rate (15%). The endoscopic approach is preferable to surgical treatment due to its lower morbidity. Objectives. 1) Present a patient with infected pancreatic necrosis resolved by Endoscopic Ultrasound (EUS) guided drainage with a luminal apposition metal stent (LAMS) and Direct Endoscopic Necrosectomy (DEN). 2) Report placement of the LAMS Hot Axios ® (Boston Scientific) for the first time ever in Argentina. Methods. Male, 38 years old, without relevant history. He is hospitalized for a severe acute biliary pancreatitis (AP), early satiety and digestive intolerance. At 4 weeks, CT scan shows a PFC of 16 cm. EUS-guided drainage was performed with LAMS Hot Axios ®, draining 1600 ml of brown liquid content. Ten days later, another episode of severe AP. Continuous fever. New CT and EUS, showed increased collection, in situ stent and necrosis inside (WON). Four sessions of DEN through-the-LAMS and laparoscopic cholecystectomy were performed. Percutaneous drainage of left pararenal necrosis. Nasojejunal tube feeding between each necrosectomy. At 8th week, absence of necrosis and granulation tissue was observed, then the LAMS was removed. Hospital discharge. After 6 months of follow up, CT control showed normal pancreatic parenchyma. Conclusions. EUS-guided drainage of Pancreatic fluid collections (PFC) with LAMS is a safe procedure. In cases of WON, LAMS also allows transluminal interventional procedures, expediting the treatment of pancreatic necrosis, in a minimally invasive way.

Acute biliary pancreatitis: a prospective observational hospital-based study

Background: Acute biliary pancreatitis (ABP) is one of the most serious complications of gall stone disease with a high risk of morbidity and mortality. Hence accurate diagnosis and prompt management of ABP is very crucial. Different management strategies exist regarding indications and timing for interventions, endoscopic retrograde cholangio-pancreaticography (ERCP) and cholecystectomy.Methods: Ours is a prospective observational study of the different clinical presentations and management strategies and their respective outcomes in our hospital. All cases of ABP admitted over a period of one year were included in the study. The clinical presentation, severity and course of the disease, imaging studies, duration of ICU and hospital stay and timing of ERCP and cholecystectomy were studied.Results: A total of 56 cases were included in the study. Average age was 45 years. Pain abdomen was the most common symptom at presentation. About 82% patients had mild to moderate disease while the rest had severe disease. The mean duration of intensive care unit stay was 8 days. ERCP was done in 6 cases. Cholecystectomy during the same admission was dine in 20 cases. There were 2 deaths during the course of the study.Conclusions: Early intervention definitely reduces morbidity, mortality and recurrent admissions in cases of acute biliary pancreatitis. Same admission laparoscopic cholecystectomy is preferable in mild ABP. All cases of severe ABP must undergo early ERCP irrespective of biliary obstruction. This also helps in reducing readmissions due to pancreatic-biliary complications and is cost-effective.

570 – Early Endoscopic Retrograde Cholangiography with Biliary Sphincterotomy Or Conservative Treatment in Predicted Severe Acute Biliary Pancreatitis (APEC): A Multicenter Randomized Controlled Trial

570 – Early Endoscopic Retrograde Cholangiography with Biliary Sphincterotomy Or Conservative Treatment in Predicted Severe Acute Biliary Pancreatitis (APEC): A Multicenter Randomized Controlled Trial