GASTROENTEROLOGY ARTICLE OF THE WEEK
September 18, 2003
Fogel EL, Sherman S. Acute biliary pancreatitis: When should the endoscopist intervene? Gastroenterology 2003;125:229-235.
1. Ranson criteria in acute pancreatitis
a. Score of 2 or less is indicative of mild pancreatitis
b. Score of 5 or higher mandates ICU admission
c. Score of 3 or more indicate severe pancreatitis
d. The criteria are modified if cholelithiasis is present
True or False
2. A 3-fold or greater increase in ALT in the presence of acute pancreatitis has a 95% positive predictive value in diagnosing acute gallstone pancreatitis.
3. A normal common bile duct diameter is a strong argument against gallstone pancreatitis.
4. After an episode of biliary pancreatitis, the cholecystectomy should be delayed by several weeks to allow the pancreas to heal.
5. All patients with suspected biliary pancreatitis should undergo early ERCP.
6. Bilirubin elevation has a lower positive predictive power for gallstone pancreatitis compared to ALT elevation.
7. All patients with suspected biliary pancreatitis should undergo ERCP prior to cholecystectomy.
8. Most patients with severe biliary pancreatitis (Ranson > 3) should undergo ERCP within 72 hours of presentation.