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Gallstone Pancreatitis with CBD Stone — RACP Adult Medicine MCQ

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EasyGastroenterologyGallstone Pancreatitis with CBD StoneRACP Adult Medicine

A 45-year-old woman presents with acute pancreatitis (lipase 2500 U/L). Ultrasound shows multiple gallstones with a dilated common bile duct (12 mm) and a 10 mm stone in the CBD. She has obstructive LFTs (bilirubin 85 μmol/L, ALP 380 U/L). What is the most appropriate management after initial resuscitation?

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Correct answer: E — Urgent ERCP with sphincterotomy and stone extraction

Gallstone pancreatitis with persistent CBD stone (dilated CBD + stone + obstructive LFTs) requires urgent ERCP (within 24-72 hours) for sphincterotomy and stone extraction. The APEC trial confirmed benefit of early ERCP in gallstone pancreatitis with cholangitis or persistent biliary obstruction. Cholecystectomy should be performed during the same admission after pancreatitis resolves (PONCHO trial). If no cholangitis and LFTs improving, MRCP first may be appropriate.

Reference: GESA – 2024 – Gallstone Pancreatitis; APEC Trial; eTG GI 2024