الفهرس 
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Abstract
Acute pancreatitis is one of the major causes of gastrointestinal admission in hospitals. Its annual incidence is ranging from 4.5 to 35 per 100000 in the USA (1). The overall mortality of acute pancreatitis ranges from 1-2% but in severe form it is much higher (11). Biliary pancreatitis commonly accounting for 35% to 65% of cases of acute pancreatitis. It occurres when a gallstone is passing into the bile duct and temporarily loading at sphincter of Oddi (2).
The co -localization theory by union between zymogen and lysozyme granules is commonly accepted as a triggering event of pancreatitis (5). While an increase in the intracellular calcium is very recently proved to have a pivotal role in pancreatitis (18). In most cases usually accounted to 85% of cases the stone passes spontaneously while in the rest it remains impacted for more than 48 hours. Those cases that will be at high risk of progressing to severe pancreatitis (5).
The time lapse of stone impaction at the sphincter of Oddi is of great importance in determining the severity of pancreatitis. This is clarified by low incidence of severe pancreatitis if the stone was impacted less the 24 hours, meanwhile the incidence of severe pancreatitis rises significantly if the stone is impacted for more than 48 hours (9).
About half of the deaths in acute pancreatitis occurres in the first week due to multiorgan failure while the other half occurres much later due to also multiorgan failure also but here it is due to infectious complications (11). On the other hand pancreatitis has its local complications that are usually delayed such as abscess, psuedopancreatic cyst and walled of pancreatic necrosis (17).
ERCP is used to remove the stones from the ampulla by many methods such as balloon or basket (21) but has its own complications such as perforation, bleeding, infection, basket entrapment and most importantly pancreatitis per se (28, 29).
There were many studies done to answer a logical question which is; does early intervention by early ERCP affect the progression of the pancreatitis from mild to severe one?
A study done at the UK made by Neoptolomas on patients with mild pancreatitis expected to have severe one by modified glasgow criteria concluded that there were a significant difference in morbidity in those subjected to early ERCP while mortality incidence did not differ significantly. With considering that he had many negative cases reaching 40% (5) while other studies neglect any benefit of ERCP in the absence of cholangitis (5).
Thus the role of ERCP in acute biliary pancreatitis in the absence of cholangitis is still controversial.