Editing Acute pancreatitis (section)

=== Indications for ERCP: ===

** Cholangitis
*** Cholangitis = fever + any of: CBD stones OR dilated CBD OR progressive cholestasis (bili >40). If cholangitis is suspected, aim ERCP within 24 hours.
** Persistent CBD obstruction
*** Dilated CBD
*** Obstructing stone in CBD on MRCP (consider at 72 hours)
*** Increasing LFTs without cholangitis (do MRCP first - usually do it after 24-48 hours - give them a chance to improve on their own - could be just pancreatic head oedema)
* Urgent ERCP doesn't make a difference in patients with severe acute gallstone pancreatitis if they don't have cholangitis or significant cholestasis - might as well treat conservatively and take out GB after a few days if possible - Lancet article. Cholangitis will happen more often in conservatively-managed patients, but just do an ERCP at that point.
* ERCP and sphincterotomy effectively prevents recurrent biliary pancreatitis and is especially useful in elderly patients (according to Schein)
[[File:GSP algorithm.png|right|frameless|530x530px]]