Endoscopic Management of the Complications of Acute Pancreatitis Jonathan M. Buscaglia, MD, FASGE Associate Professor, Department of Medicine Director, Interventional Endoscopy Program Stony Brook University School of Medicine

Objectives • To provide an evidence-based review on the role of ERCP for the management of acute biliary pancreatitis (ABP)

• To discuss some recent, important studies on the endoscopic management of pancreatic fluid collections – Uncomplicated pancreatic pseudocysts – Walled-Off Pancreatic Necrosis (WOPN)

Acute Biliary Pancreatitis (ABP) • Most cases are mild and do not require endoscopic intervention • Mortality rate of an initial episode of ABP ~10%1 • 25% of ABP attacks are severe – Mortality rate ~30%2

• Without definitive treatment, risk of recurrent attack of ABP within 6 months is 30-50%3,4 1. 2. 3. 4.

Mayer AD, et al. Ann R Coll Surg Engl 1984; 66:179-83. Mayerle J, et al. Gastroenterol Clin North Am 2004; 33:855-69. Ranson JH. Ann Surg 1979; 189:654-62. Kuo VC, et al. Gastrointest Endosc Clin North Am 2013; 23:749-68.

Questions to Ask During an Episode of ABP • When should ERCP be considered? • When should urgent ERCP be considered? • What endoscopic therapy should be performed during the ERCP?

Prospective Studies on ERCP in ABP Study

Year

Design

Timing

ERCP Group

Neoptolemos et al

1988

RCT