Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 27: An Elderly Patient With Multiple Medical Problems Presents With Acute Pancreatitis And Stones In The Gallbladder. Lfts Show Ast Of 90 And Alt Of 95, Both Declining. Mrcp Shows No Cbd Stones Or Ductal Dilation. Is Ercp Indicated? (continued)

Stuart Sherman, MD

This patient has multiple medical problems and clearly has pancreatitis. In deciding whether an endoscopic retrograde cholangiopancreatography (ERCP) is indicated, I would want to know whether the pancreatitis is due to bile duct stones. Distinguishing biliary pancreatitis from other causes may be difficult, and often requires an extensive biochemical and radiologic evaluation. Finding gallbladder stones, as in this case, is suggestive but not conclusive of a biliary origin. A serum amylase level greater than 1000 IU/L should suggest a biliary tract origin, although some overlap exists with…