The major indication for ERCP in acute pancreatitis (AP) has been in the setting of presumptive biliary pancreatitis in which there is a concern for impacted or ball-valving common bile duct stones. Epidemiologically, there appears to have been an almost exponential increase in gallstone pancreatitis over the years. To some degree, improved diagnosis by ERCP, MR cholangiopancreatography and endoscopic ultrasound has contributed to this apparent increase. Differentiation from non-biliary pancreatitis, however, is important for management. A biliary cause of AP should be strongly considered when any or all of these abnormalities are present: jaundice, cholangitis, serum amylase > 13.4
kat/l, serum transaminases > 3× normal, and gallstones or dilated biliary ducts on ultrasound. Conservative management of acute biliaray pancreatitis is succesful in 70–80% of patients, although some may develop biliary sepsis and other complications; mortality in these patients is from 13% to 50%. There is a debate about the likelihood of persistent stone based upon common bile duct diameter, biochemical abnormalities and the presence or absence of concomitant cholangitis. One third to two thirds of patients with persistent gallstones have a second attack of AP, usually within months. In this literature review we set forth the indications for urgent ERCP and the significance of endoscopic treatment in the management of acute biliary pancreatitis and prevention of pancreatitis recurrences.

        Key words: acute biliary pancreatitis – urgent ERCP – endoscopic papilosphincterotomy