Clinical Research Directory

Inclusion Criteria: 1. adult patients (above 18 years) 2. naïve papilla 3. evidence of AP based on the Atlanta criteria: * pain in the upper abdomen * serum amylase or lipase concentration \> 3 times the upper limit of normal * imaging features of acute pancreatitis on abdominal imaging 4. high probability of a biliary etiology: * gallstones or biliary sludge on imaging (any type) * dilated common bile duct on imaging defined as \> 8 mm in patients ≤ 75 years or \> 10 mm in patients \> 75 years * abnormal liver enzymes (alanine aminotransferase \[ALT\] two times the upper limit of normal) 5. patients unfit for surgery due to the attending physician's decision e.g. American Society of Anesthesiologists (ASA) class ≥ III; severe heart failure with reduced ejection fraction \<40%, severe uncontrolled hypertension, chronic kidney disease stage four or five Exclusion Criteria: 1. previous cholecystectomy 2. previous endoscopic sphincterotomy or pancreatobiliary stenting 3. ERCP/ES is recommended by the guidelines (3) * sign of cholangitis * presence of CBD stone on any imaging * signs of stone in endoscopic ultrasonography or magnetic resonance imaging in case of abnormal liver enzymes (persistently elevated ALT and aspartate aminotransferase (AST) with less than a 20% decrease over four days) or dilated CBD (defined as above) 4. chronic pancreatitis 5. estimated life expectancy \< 12 months 6. ERCP is contraindicated, e.g. the procedure cannot be carried out safely due to the patient's comorbidities or physical status; high risk of bleeding or contraindication of the discontinuation of the anticoagulation therapy. 7. ERCP is technically not feasible due to altered anatomy, e.g., total gastrectomy, Roux-en-Y gastric bypass anatomy 8. pancreatobiliary malignancy