Is E.R.C.P. indicated in a patient with bile stone pancreatitis with s/s of cholangitis and high level serum amylase?

Pancreatitis is an inflammation of the pancreas. Gallstones are the single most common etiology of acute pancreatitis. During diagnoise of pancreatitis Blood amylase or lipase will be4-6 times higher than the Amylase or lipase is frequently part of the diagnosis; lipase is generally considered a better indicatorormal variations, but this will be dependent on the laboratory that is testing the blood. As with mild acute pancreatitis, it will be necessary to treat the underlying cause - gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that an ERCP procedure or removal of the gallbladder will be recommended. cholangitis is an infection of the bile duct. Bile duct obstruction, which is usually present in acute cholangitis, is generally due to gallstones. Routine blood tests show raised bilirubin, alkaline phosphatase and γ-glutamyl transpeptidase. In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in hepatitis, with elevations in alanine transaminase and aspartate transaminase. The gold standard test for biliary obstruction is still endoscopic retrograde cholangiopancreatography (ERCP). Ultrasound can help distinguish between cholangitis and cholecystitis (inflammation of the gallbladder), which has similar symptoms to cholangitis but appears differently on ultrasound.

In the absence of cholangitis and / or jaundice, MRCP or endoscopic ultrasound (EUS) rather than diagnostic ERCP should be used to screen for choledocholithiasis if highly suspected (conditional recommendation, low quality of evidence).