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OBJECTIVE::To test the hypothesis that early endoscopic intervention, performed onpatients with acute gallstone pancreatitis and biliopancreatic obstruction,reduces systemic and local inflammation. SUMMARY BACKGROUND DATA:: The role ofearly endoscopic intervention, in the treatment of acute gallstonepancreatitis, remains controversial. Previous randomized trials have notfocused on the subgroup of patients with clinical evidence of biliopancreaticobstruction. METHODS:: This single-center randomized clinical trial was performedbetween May 2000 and September 2005. Of 238 patients, admitted within 48 hoursafter the onset of acute gallstone pancreatitis, 103 with a distal bile ductmeasuring >/=8 mm combined with a total serum bilirubin >/=1.20 mg/dL,were randomized to receive either endoscopic retrogradecholangiopancreatography followed by endoscopic papillotomy for bile ductstones (EEI, n = 51) or early conservative management (ECM, n = 52). Patientswith clinical evidence of coexisting acute cholangitis were excluded. Outcomemeasures included changes in organ failure score and computed tomography (CT)severity index during the first week after admission, incidence of localcomplications, and overall morbidity and mortality. RESULTS:: The incidence ofbile duct stones at EEI was 72% and 40% of patients in the ECM group hadpersisting bile duct stones at elective biliary surgery. No significantdifferences were found between the EEI and ECM groups regarding changes in meanorgan failure score (P = 0.87), mean CT severity index (P = 0.88), incidence oflocal complications (6% vs. 6%, P = 0.99), overall morbidity (21% vs. 18%, P =0.80), and mortality (6% vs. 2%, P = 1). CONCLUSIONS:: The present study failedto provide evidence that early endoscopic intervention reduces systemic andlocal inflammation in patients with acute gallstone pancreatitis andbiliopancreatic obstruction. If acute cholangitis can be safely excluded, earlyendoscopic intervention is not mandatory and should not be considered astandard indication.Leggil'articolo