The Timing And Possible Mechanism Of ERCP In The Treatment Of Acute Biliary Pancreatitis

Objective:To study the timing and possible mechanism of endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of acute biliary pancreatitis(ABP).Methods:The data of 101 patients with ABP were retrospectively analyzed.Receiver operating characteristic(ROC)curve was used to calculate the optimal cut-off time of ERCP in the treatment of ABP.The patients were divided into early ERCP group and late ERCP group,and the patients in the early ERCP groups were divided into subgroups according to the result of the ROC curve.Primary endpoints were exacerbation rate,incidence of new onset of organ failure(NOF)and mortality.Secondary endpoints were clinical scores(APACHE II,RANSON,Marshall,GCSI),serological variables(C-reactive protein,IL-6,IL-10,TNF-?,triglyceride)and incidence of ERCP related complications.Logistic regression was used to explore the risk factors of the exacerbation of ABP.Results:The ROC curve analysis showed that 66 hours after the onset of ABP was the best cut-off time of ERCP.Exacerbation rate,incidence of NOF and infection rate were significantly lower in the early ERCP group(within 66 hours after onset)than in the late ERCP group(over 66 hours after onset).Scores of APACHE II,Marshall,GCSI,and serological variables(CRP,IL-6,IL-10,triglyceride,albumin)were significantly improved in the early ERCP group.The hospital/ICU stay were significantly shorter and hospitalization costs were significantly less in the early ERCP group.There was no significant difference in mortality and incidence of ERCP-related complications between the two groups.There was no significant difference within the early ERCP subgroups.Logistic regression showed that elevated serum triglyceride and GCSI scores were risk factors,while early ERCP treatment as a protective factor,of the exacerbation of ABP.Conclusion:Early ERCP treatment(within 66 hours after the onset)could reduce the risk ofexacerbation and improve the prognosis of patients with ABP,the possible mechanism of which is to improve the intestinal function and reduce serum triglyceride.