The Leicester group randomly assigned 121 patients with suspected ABP to receive either conservative therapy or ERCP within 72 h of admission. Patients who were found to have choledocholithiasis then underwent ES and stone extraction. The severity of pancreatitis was graded according to a modification of the Glasgow criteria. Of the 121 patients, 59 (25 of whom had severe pancreatitis) underwent ERCP and 62 (including 28 with severe pancreatitis) received conventional treatment.
ERCP was technically successful in 94% of patients with mild and 80% of those with severe pancreatitis, and common bile duct (CBD) stones were found in 25% and 63% of cases, respectively. All CBD stones were removed endoscopically without complication. This study yielded several important findings.
• ERCP could be safely performed in patients with ABP in a specialized centre.
• Compared with conventional therapy, ERCP reduced the morbidity (24% versus 61%) and mortality (4% versus 18%) of patients with severe pancreatitis.
• ERCP was associated with reduced hospital stays for patients with severe pancreatitis.
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