Objective:To explore the optimal therapeutic strategy for acute biliary pancreatitis (ABP).
Methods:The clinical data of 159 patients with acute biliary pancreatitis treated in our hospital over a period of five years were retrospectively analyzed. The cases were divided into four types according to severity of disease and bile duct obstruction: Mild cases without bile duct obstruction (n=68); mild cases with bile duct obstruction (n=43); severe cases without bile duct obstruction (n=27); and severe cases with bile duct obstruction  (n=21). All cases received conservative treatment soon after admission. There were 64 cases with bile duct obstruction who underwent therapeutic endoscopy or open surgery to relieve bile duct obstruction.The time to relief of abdominal pain, the time of serum amylase returned to normal level，days of hospital stay，recovery rate，incidence of complications and fatality rate in the four groups with different therapeutic protocol were analyzed and compared.
Results:The clinical manifeslations of 95 cases without bile duct obstruction were improved after receiving conservative treatment, and there was no significant difference of the tested  indexes between the mild group and severe group (P＞0.05). All of the 64 cases with bile duct obstruction undergoing emergency operation, there was significant improvement of monitored indexes in the endoscopic therapy group (38 cases) in comparison with the open surgery group (26 cases) (P＜0.05).
Conclusions:The treatment of ABP should be selected according to the type of ABP. The non-operation protocol is effective for mild cases without bile duct obstruction; for the cases with bile duct obstruction, conservative treatment should be followed by either endoscopic biliary drainage or open surgery, and the endoscopic drainage should be preferred because of its mini-invasive advantage.