Abstract:Objective:To investigate the timing of endoscopic therapy of obstructive acute biliary pancreatitis.
Methods :Three hundrend and sixty cases of obstructive acute biliary pancreatitis treated by endoscopy were analyzed.The patients were divided into two groups: One hundred and sixty-eight cases received emergency endoscopic therapy (EE group） within 48 hours from the onset of symptoms，including endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy（ERCP+ES）, with or without stone extraction and endoscopic naso-biliary drainage（ENBD）;192 cases received delay endoscopic therapy（DE group）after initial 48 hours of conservative management.
Results:The total success rate of therapeutic endoscopy was 96.9 %. The time for disappearance of abdominal pain, the time for serum amylase level、serum bilirubin level and WBC count to return to normal, and the length of hospitalization were significantly shorter in EE group than those in DE group（all P<0.05-0.001）.In cases with severe acute biliary pancreatitis,the morbidity in the EE group was significantly lower than DE group（9.6 %vs28.9 %,P<0.05）, but the difference in mortality rate between the two groups was not significant（P>0.05）. In cases of mild acute biliary pancreatitis, morbidity and mortality rate between the EE and DE groups were not significantly different（P>0.05）.
Conclusions:This study shows that in severe acute biliary pancreatitis patiens with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms; patients with mild acute biliary pancreatitis shoud also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.