A recent case vignette highlights several key points regarding use and timing of ERCP (endoscopic retrograde cholangiopancreatography) for gallstone pancreatitis (NEJM 2014; 370: 150-7). Figure 1 provides a nice illustration of ERCP.

Indications:  Suspected bile-duct stones as the cause of pancreatitis AND one of the following:

• cholangitis (fever, jaundice, sepsis)
• persistent biliary obstruction (conjugated bilirubine level >5 mg/dL)
• clinical deterioration (worsening pain, increasing white cell count, worsening vital signs)
• stone evident in the common bile duct on imaging

AGA position paper (2007):

• Urgent ERCP (within 24 hours of admission) was recommended in those with cholangitis
• Early ERCP (within 72 hours of admission) was recommended if suspicion of persistent bile-duct stones remained high

Patient information/animated videos for pancreatic diseases from the National Pancreas Foundation: http://ow.ly/sF9vb 

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