1 Jan 2023Article
Acute biliary pancreatitis: the current role of endoscopic and minimally invasive surgical procedures
Martino Gerosa 1Marco Chiarelli 2Dario Maggioni 1Ugo Cioffi 3Angelo Guttadauro 4
Affiliations
Article Info
1 Laparoscopic and Oncological General Surgery Department, Desio Hospital, ASST Brianza, Desio, Italy
2 Department of Surgery, ASST Lecco, Lecco, Italy
3 Department of Surgery, University of Milan, Milano, Italy
4 Department of Surgery, University of Milan “Bicocca”, Istituti Clinici Zucchi, Monza, Italy
Ann. Ital. Chir., 2023, 94(1), 36-44;
Published: 1 Jan 2023
Copyright © 2023 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
AIM: This review aims to summarize the state of the art in endoscopic and other minimally invasive technique for the treatment of acute biliary pancreatitis. Current indications, advantages or disadvantages for each reported technique and future perspectives are discussed. BACKGROUND: Acute biliary pancreatitis is one of the most common gastroenterological diseases. Its management range from medical to interventional treatment and involves gastroenterologists, nutritionists, endoscopists, interventional radiologists and surgeons. Interventional procedures are required in case of local complications, failure of medical treatment and definitive treatment of biliary gallstones. Endoscopic and minimally invasive procedures have progressively gained favor and wide diffusion in treating acute biliary pancreatitis reporting good results in terms of safety and minor morbidity and mortality. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is advocated in case of cholangitis and persistent common biliary duct obstruction. Laparoscopic cholecystectomy is considered the definitive treatment for acute biliary pancreatitis. Endoscopic transmural drainage and necrosectomy have gained acceptance and diffusion in treating pancreatic necrosis reporting minor impact on morbidity respect surgery. A surgical approach to pancreatic necrosis progressively shifts towards minimally invasive technique like minimally access retroperitoneal pancreatic necrosectomy, video-assisted retroperitoneal debridement or laparoscopic necrosectomy. Open necrosectomy in necrotizing pancreatitis is reserved to failure of endoscopic or minimally invasive treatment or in case of wide necrotic collections
Keywords
- Acute biliary pancreatitis
- Endoscopic retrograde cholangiopancreatography
- Laparoscopic cholecystectomy
- Pancreatic necrosis