A second RCT was undertaken at the University of Hong Kong, where the incidence of choledocholithiasis as a cause of AP is quite high. Because of this fact, the results may not be applicable to other parts of the world. The investigators randomly assigned 195 patients with AP to early ERCP (within 24 h of admission) or conventional treatment. A severe attack was defined as one in which the serum urea concentration exceeded 45 mg/dL (16.2 mmol/L) and the plasma glucose concentration was greater than 198 mg/dL (11.0 mmol/L) on admission.
Biliary stones were present in the majority of the patients (127 of 195, or 65%). Of the 97 patients who underwent ERCP, 64 were found to have gallstones, and 37 patients with CBD stones underwent ES. Of the 63 patients with gallstones who were allocated to receive conventional therapy, 22 subsequently deteriorated and underwent ERCP. Ten of these patients proved to have choledocholithiasis. Endoscopic management reduced the morbidity (from 54% to 13%) and the mortality (from 18% to 3%) in patients with severe pancreatitis.
Both of these studies demonstrated the benefits of ERCP and ES in patients with severe AP, but neither found that the outcomes were improved in patients with mild disease. It is possible that the majority of practitioners may not be able to achieve the results described in these single-centre studies. Other studies with similar designs have not been undertaken, perhaps because of formidable logistical and perhaps even ethical barriers. Although some authorities have questioned the validity of the criteria for severe pancreatitis used in these studies, they are practical, have adequate sensitivity and specificity, and have been widely adopted in clinical practice. Cheapest online shopping is waiting for you to enjoy it as much as you wanted! This is the chance you were looking forward to, so why not go for it right now and finally buy cialis super active online at our place at best fully-licensed pharmacy?