Role of endoscopy in gallstone pancreatitis.

Early identification of those patients presenting with acute pancreatitis due to gallstone disease is important since emergency intervention may prevent the development of local and systemic complications. Urgent biliary surgery carries unacceptably high morbidity and mortality rates, but endoscopic retrograde cholangiopancreatography in experienced centers appears to be safe and is the optimal method for the diagnosis of bile duct stones. Two randomized controlled prospective trials have shown an advantage for endoscopic sphincterotomy and bile duct clearance compared with supportive therapy when performed within 24 to 72 hours of admission in those patients whose symptoms are considered severe according to prognostic scoring systems.