Prediction of common bile duct stones and cholangitis in acute biliary pancreatitis

Objective: To define factors in predicting common bile duct (CBD) stones and cholangitis in patients with acute biliary pancreatitis. Method: Retrospective analysis of patients with acute biliary pancreatitis who received early (< 72 h) endoscopic retrograde cholangiopancreatography (ERCP). Data on their clinical presentation, severity of attacks, liver function on admission, ERCP findings and bile culture results were analysed. Results: Sixty-four patients admitted with acute biliary pancreatitis were referred for early ERCP. Common bile duct stones were found in 33 patients (52%). Only five (8%) patients presented with symptoms suggestive of coexisting acute cholangitis (fever, abdominal pain and jaundice). Bile cultures were positive in 12 of 18 specimens (67%), and nine of these (75%) were associated with choledocholithiasis. Variables were entered into a logistic regression analysis and a high bilirubin level on admission was the only significant factor in predicting ductal stones. Conclusion: In the locality of Hong Kong the incidence of choledocholithiasis is high in acute biliary pancreatitis and only a high bilirubin level can predict CBD stones. Although many patients have infected bile, overt cholangitis is relatively uncommon. Chinese Abstract Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract. Figure Chinese Abstract.