Endoscopic cholangiopancreatography in stone-induced cholangitis and pancreatitis: indications and controversies

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a fundamental diagnostic and therapeutic procedure in the management of complicated biliary lithiasis, such as acute cholangitis and biliary pancreatitis—conditions that are frequent causes of gastrointestinal emergencies. Given the high prevalence of these diseases and the risk of severe complications due to biliary obstruction, it is essential to understand the indications and limitations of ERCP in emergency settings. This study aimed to review recent scientific evidence regarding the use of ERCP in the treatment of patients with biliary complications, analyzing its main indications, contraindications, and the impact of timing on clinical outcomes. A narrative literature review was conducted using the PubMed and UpToDate databases, with the descriptors “ERCP”, “acute cholangitis”, “gallstone pancreatitis”, and “emergency”. The results indicate that, in cases of acute cholangitis, ERCP is preferably indicated within the first 24 to 48 hours, especially in severe cases, as it reduces complications and hospital stay. In biliary pancreatitis, ERCP is recommended only in the presence of cholangitis or evident bile duct obstruction; in the absence of these factors, early ERCP is not indicated. In conclusion, ERCP is an essential tool in biliary emergencies, with its indication depending on the clinical severity, providing significant benefits when applied appropriately and in a timely manner.