ImportanceGallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor. In addition, there is minimal evidence to guide clinicians in the treatment of moderately severe and severe pancreatitis.ObservationsThe management of GSP continues to evolve and is dependent on severity of acute pancreatitis and concomitant biliary diagnoses. Across the spectrum of severity, there is evidence that goal-directed, moderate fluid resuscitation decreases the risk of fluid overload and mortality compared with aggressive resuscitation. Patients with isolated, mild GSP should undergo same-admission cholecystectomy; early cholecystectomy within 48 hours of admission has been supported by several randomized clinical trials. Cholecystectomy should be delayed for patients with severe disease; for severe and moderately severe disease, the optimal timing remains unclear. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is only useful for patients with suspected cholangitis or biliary obstruction, although the concomitance of these conditions in patients with GSP is rare. Modality of evaluation of the common bile duct to rule out concomitant choledocholithiasis varies and should be tailored to level of concern based on objective measures, such as laboratory results and imaging findings. Among these modalities, intraoperative cholangiography is associated with reduced length of stay and decreased use of ERCP. However, the benefit of routine intraoperative cholangiography remains in question.Conclusions and RelevanceTreatment of GSP is dependent on disease severity, which can be difficult to assess. A comprehensive review of clinically relevant evidence and recommendations on GSP severity grading, fluid resuscitation, timing of cholecystectomy, need for ERCP, and evaluation and management of persistent choledocholithiasis can help guide clinicians in diagnosis and management.

中文翻译：

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胆石性胰腺炎的治疗

重要性胆石性胰腺炎 (GSP) 是急性胰腺炎的主要原因，约占急性胰腺炎病例的 50%。如果没有适当和及时的治疗，患者疾病进展和复发的风险就会增加。虽然轻度普惠制管理指南之间的共识日益增多，但这些指南的遵守情况仍然较差。此外，指导临床医生治疗中重度和重度胰腺炎的证据很少。观察 GSP 的治疗持续发展，并取决于急性胰腺炎的严重程度和伴随的胆道诊断。在各种严重程度中，有证据表明，与积极复苏相比，目标导向的适度液体复苏可降低液体超负荷和死亡的风险。孤立的轻度 GSP 患者应在入院时接受胆囊切除术；入院 48 小时内进行早期胆囊切除术已得到多项随机临床试验的支持。对于病情严重的患者应推迟胆囊切除术；对于重度和中重度疾病，最佳时机仍不清楚。术前内镜逆行胰胆管造影（ERCP）仅对疑似胆管炎或胆道梗阻的患者有用，尽管 GSP 患者同时患有这些疾病的情况很少见。用于排除伴随胆总管结石的胆总管评估方式各不相同，应根据实验室结果和影像学检查结果等客观指标，根据关注程度进行调整。在这些方式中，术中胆管造影与住院时间缩短和 ERCP 使用减少相关。然而，常规术中胆管造影的益处仍然存在疑问。结论和相关性 GSP 的治疗取决于疾病的严重程度，而疾病的严重程度可能难以评估。对 GSP 严重程度分级、液体复苏、胆囊切除术时机、ERCP 需求以及持续性胆总管结石的评估和治疗等临床相关证据和建议进行全面审查，有助于指导临床医生的诊断和治疗。