Early ERCP and Papillotomy for Acute Biliary Pancreatitis

To the Editor: Fölsch et al. (Jan. 23 issue) 1 concluded that in patients with acute biliary pancreatitis but without obstructive jaundice, early endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy were not beneficial. Unfortunately, their report falls short of providing the necessary data to support this conclusion. More specific information about the timing of ERCP is required. Acinar-cell injury occurs early (within hours) after pancreatic ductal obstruction in experimental studies of acute biliary pancreatitis. 2 In the study by Fölsch et al., patients in the invasive-treatment group underwent ERCP within 72 hours after the onset of pain. What was the median delay (and . . .