HNY Policy and Pathway Repository - North Yorkshire

Acute gallstone pancreatitis

This intervention is commissioned if there is:

• evidence of cholangitis OR
• obstructive jaundice AND imaging evidence of a stone in the common bile duct

 

N.B. Early ERCP means ERCP performed during an acute admission with gallstone pancreatitis, ideally within 24 hours of admission.

ERCP is an invasive procedure and carries 5-10% morbidity and 0.1%-0.5% mortality. Risks of endoscopy apply and specific risks of ERCP are pancreatitis, cholangitis, bleeding and retroduodenal perforation. Therefore, Early ERCP should be reserved for cases when a therapeutic intervention is likely and most effective.

 

ERCP for acute pancreatitis without cholangitis has been shown to have a higher mortality rate and is of little benefit in comparison to delayed ERCP.

 

NICE quality statements for gallstones include:

 

QS2 Endoscopic retrograde cholangiopancreatography can be used to treat common bile duct stones. Adults should have the procedure performed within 72 hours of diagnosis of common bile duct stones if these are causing jaundice, to prevent further complications such as cholangitis while waiting for treatment.

 

QS3 Endoscopic retrograde cholangiopancreatography can be used to treat common bile duct stones. Not everybody will need this procedure within 24 hours, but emergency endoscopic retrograde cholangiopancreatography can improve outcomes for adults with acute cholangitis or acute pancreatitis if their condition is not responding to antibiotics or intravenous fluids. Delaying endoscopic retrograde cholangiopancreatography for adults with these conditions risks complications such as sepsis.

Early endoscopic retrograde cholangiopancreatography (ERCP) in acute gallstone pancreatitis without cholangitis - EBI

QS104 Gallstone disease NICE