The Early Treatment of Acute Biliary Pancreatitis

To the Editor: A problem with the study by Fan et al. (Jan. 28 issue)¹ is the authors' inability to distinguish reliably patients presenting with acute pancreatitis and secondary biliary obstruction from those presenting with primary biliary obstruction and sepsis. At least one of the patients randomly assigned to initial conservative treatment had a serum bilirubin concentration of 37.2 mg per deciliter. Patients who present with acute abdominal symptoms, fever, and leukocytosis should probably undergo emergency endoscopic retrograde cholangiopancreatography (ERCP), regardless of their serum amylase concentrations². Furthermore, even in patients with unequivocal pancreatitis, potentially life-threatening biliary obstruction cannot always…