Unifying Concepts

Indications and Contraindications for ERCP in Patients with Acute Biliary Pancreatitis

Recent guidelines published by the American College of Gastroenterology suggest that urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 hours after admission) is indicated in patients with biliary pancreatitis who have concurrent acute cholangitis, but it is not needed in most patients who do not have evidence of ongoing biliary obstruction.

Indications and Contraindications for ERCP in Patients with Acute Biliary Pancreatitis


Suspected bile-duct stones as the cause of pancreatitis established clinically, and one of the following:

  • Cholangitis (fever, jaundice, sepsis)
  • Persistent biliary obstruction (conjugated bilirubin level >5 mg/dl [86 µmol per liter])
  • Clinical deterioration (worsening pain, increasing white-cell count, worsening vital signs)
  • Stone detected in the common bile duct on imaging


  • Unstable medical condition precluding safe administration of moderate sedation or general anesthesia
  • Decision by competent patient not to provide consent for the procedure
  • Endoscopist with inadequate training in ERCP

Relative (may be overcome)

  • Anatomical condition (gastroduodenal disease or surgical alteration) that would impede endoscopic access to the major papilla; may be overcome in the case of a long Roux limb, for example, with the use of modified equipment and accessories
  • Clinically significant or uncorrectable coagulopathy; may be overcome, since a biliary stent can be placed without need for sphincterotomy



  1. Fogel EL, Sherman S. ERCP for gallstone pancreatitis. N Engl J Med. 2014 Jan 9;370(2):150-7. [Medline]
  2. Canlas KR, Branch MS. Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis. World J Gastroenterol. 2007 Dec 21;13(47):6314-20.[Medline]


Created Jan 15, 2014.

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