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The impact of empiric endoscopic biliary sphincterotomy on future gallstone-related complications in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed

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Abstract

Background

Early cholecystectomy (EC) is recommended in patients with acute biliary pancreatitis (ABP). In real-life practice, cholecystectomy is frequently deferred due to various reasons and delayed cholecystectomy (DC) is performed instead. Endoscopic sphincterotomy (ES) is an alternative to prevent recurrent pancreatitis, however other gallstone-related complications (GCs) may still develop. We aimed to determine the impact of ES on future GCs in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed.

Methods

During 2006–2016, we included patients with non-severe ABP while those with severe pancreatitis and concurrent cholangitis were excluded. GC events were compared between those who had DC with ES and those who had DC without ES. A similar comparison was made in patients with and without ES who did not receive cholecystectomy.

Results

Of 266 patients with ABP, non-severe ABP was identified in 146. Only 16 (11%) had EC. Of patients with non-severe ABP who underwent DC (n = 88), recurrent ABP in the ES group was lower than those from the non-ES group (2% vs. 17%; p = 0.01). Acute cholecystitis was found in 0%, 6% and 10% of patients with EC, DC and those without cholecystectomy (p = 0.39). Of those who did not undergo cholecystectomy (n = 42), recurrent ABP in the ES group was still lower than the non-ES group (4% vs. 36%; p = 0.006). ES related complications were mild pancreatitis (4%) and post sphincterotomy bleeding (5%).

Conclusions

In patient with non-severe ABP, ES is an alternative to reduce recurrent ABP, however without EC, future cholecystitis may still develop.

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Abbreviations

ABP:

Acute biliary pancreatitis

DC:

Delayed cholecystectomy

ACG:

The American College of Gastroenterology

AGA:

The American Gastroenterological Association Institute

ES:

Endoscopic sphincterotomy

ERCP:

Endoscopic retrograde cholangiopancreatography

CBD:

Common bile duct

CCI:

Charlson Comorbidity Index

SD:

Standard deviation

UK:

The United Kingdom

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Wiriyaporn Ridtitid, Santi Kulpatcharapong, Panida Piyachaturawat, Pradermchai Kongkam & Rungsun Rerknimitr

  2. Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, 10400, Thailand

    Phonthep Angsuwatcharakon

  3. Excellence Center in GI Endoscopy, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand

    Wiriyaporn Ridtitid, Santi Kulpatcharapong, Panida Piyachaturawat, Phonthep Angsuwatcharakon, Pradermchai Kongkam & Rungsun Rerknimitr

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  1. Wiriyaporn Ridtitid
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Contributions

Conception and design (RR, WR), data collection (RR, SK, PP, PA, PK, WR), data analysis and interpretation (SK, PP, WR), manuscript drafting (SK, PP, WR), critical revision of the article for important intellectual content (RR, PA, PK, WR), final approval of the article (RR, SK, PP, PA, PK, WR).

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Correspondence to Rungsun Rerknimitr.

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Drs. Wiriyaporn Ridtitid, Santi Kulpatcharapong, Panida Piyachaturawat, Phonthep Angsuwatcharakon, Pradermchai Kongkam, and Rungsun Rerknimitr have no conflicts of interest or financial ties to disclose.

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Ridtitid, W., Kulpatcharapong, S., Piyachaturawat, P. et al. The impact of empiric endoscopic biliary sphincterotomy on future gallstone-related complications in patients with non-severe acute biliary pancreatitis whose cholecystectomy was deferred or not performed. Surg Endosc 33, 3325–3333 (2019). https://doi.org/10.1007/s00464-018-06622-9

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