Acute biliary pancreatitis: Timing of the endoscopic sphincterotomy (ES) and videolaparocholecystectomy

There is not uniformity in the literature about the timing of execution of the endoscopic sphincterotomy (ES) and then the videolaparocholecystectomy (VLC) in course of acute biliary pancreatitis (ABP): the aim of this study was to suggest the optimal timing. In the period September 1997-November 2004, 67 patients were treated for ABP. Fifteen cases were severe ABP and 52 were mild ABP. In 55 patients an ES was executed within 48-72 hours; in 12 cases the ES was delayed of 10 days. After 8-10 days, 62 patients had a VLC; 5 patients had an open cholecystectomy. The coledochal stone was removed in 32 cases (47.7%); in the last 35 patients (52.3%) the biliary sand or sludge was removed. Immediate results: 1 case (1.5%) of pancreatitis worsening, 6 cases (9.8%) of asymptomatic increase of the lypase and amylase, 2 (2.9%) duodenal perforations. In our experience, the golden therapeutic timing foresees the ES within 48-72 hours from the beginning of the symptomatology and the VLC within 8-10 days: this time is necessary to establish the absence the progression of the acute pancreatitis.