Gallstone pancreatitis--a critical review of current treatment strategies.

This review critically analyses the role of urgent biliary decompression in the management of acute gallstone pancreatitis with the emphasis on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). In an analysis of currently available prospective randomised trials the role of routine urgent ERCP with or without ES in patients with predicted severe pancreatitis is challenged. Patients with persistent biliary obstruction and associated cholangitis appear to be the only subgroup who may benefit from urgent biliary intervention.