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Background <p>The most common cause of acute pancreatitis (AP) is biliary in origin, accounting for up to 40% of all AP cases. Spontaneously passing biliary concrements can trigger biliary acute pancreatitis (BAP) by temporarily obstructing the pancreatic duct. In addition to gallstones, biliary sludge and microlithiasis can trigger acute pancreatitis.</p> Objective <p>To present the current scientific standards for the diagnosis, treatment, and recurrence prevention of BAP.</p> Results <p>The diagnosis of BAP is established via evidence of biliary concrements on imaging. Endoscopic ultrasound can confirm a&#xa0;biliary etiology in approximately 30% of idiopathic AP cases. After diagnosis of BAP, endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is only indicated in patients with concomitant cholangitis. Patients with cholangitis benefit from emergency ERCP. Every patient with BAP should undergo cholecystectomy to prevent recurrence, provided that their comorbidities allow for it. In case of mild BAP, cholecystectomy should be performed during the initial hospital stay. In severe (necrotizing) cases, surgery is recommended in the early elective setting once the inflammatory process has subsided.</p> Conclusion <p>The recent definition of microlithiasis and biliary sludge allows for a&#xa0;stratified assessment of BAP based on the underlying trigger. This enables a&#xa0;targeted evaluation of management strategies for microlithiasis- and sludge-induced pancreatitis. Open questions remain regarding timing of ERCP in severe BAP without cholangitis before discharge and the optimal timing of cholecystectomy following severe BAP.</p>

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Diagnostik und Therapie der biliären akuten Pankreatitis

  • 期刊论文

  • 发表日期：

    2025年6月16日

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  • Max Ole Hubert,
  • Bernhard Renz,
  • Julia Mayerle,
  • Simon Sirtl

摘要

Background

The most common cause of acute pancreatitis (AP) is biliary in origin, accounting for up to 40% of all AP cases. Spontaneously passing biliary concrements can trigger biliary acute pancreatitis (BAP) by temporarily obstructing the pancreatic duct. In addition to gallstones, biliary sludge and microlithiasis can trigger acute pancreatitis.

Objective

To present the current scientific standards for the diagnosis, treatment, and recurrence prevention of BAP.

Results

The diagnosis of BAP is established via evidence of biliary concrements on imaging. Endoscopic ultrasound can confirm a biliary etiology in approximately 30% of idiopathic AP cases. After diagnosis of BAP, endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is only indicated in patients with concomitant cholangitis. Patients with cholangitis benefit from emergency ERCP. Every patient with BAP should undergo cholecystectomy to prevent recurrence, provided that their comorbidities allow for it. In case of mild BAP, cholecystectomy should be performed during the initial hospital stay. In severe (necrotizing) cases, surgery is recommended in the early elective setting once the inflammatory process has subsided.

Conclusion

The recent definition of microlithiasis and biliary sludge allows for a stratified assessment of BAP based on the underlying trigger. This enables a targeted evaluation of management strategies for microlithiasis- and sludge-induced pancreatitis. Open questions remain regarding timing of ERCP in severe BAP without cholangitis before discharge and the optimal timing of cholecystectomy following severe BAP.