Endoscopic sphincterotomy for acute pancreatitis.

There is now considerable evidence linking the severity of gallstone-associated acute pancreatitis with obstruction to both the bile duct and the pancreatic duct by "persisting" stones either because of continuous or repeated impaction, or repeated passage. Two prospective trials have shown endoscopic sphincterotomy to be superior to other forms of treatment, but only in severe cases, and general experience now extends to over 1000 cases so treated. Endoscopic sphincterotomy is also very effective in acute pancreatitis associated with acute cholangitis. Prophylactic endoscopic sphincterotomy may be of benefit in elderly patients in preference to prophylactic cholecystectomy. Yet to be fully explored is the role of this procedure in the early treatment of severe non-gallstone pancreatitis and in established pancreatic necrosis.