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Surgical Endoscopy

, Volume 28, Issue 1, pp 127–133 | Cite as

Long-term effectiveness of cholecystectomy and endoscopic sphincterotomy in the management of gallstone pancreatitis

  • Abdalla MustafaEmail author
  • Irena Begaj
  • Mark Deakin
  • Damien Durkin
  • David J. Corless
  • Richard Wilson
  • John P. Slavin
Article

Abstract

Background

Gallstone pancreatitis (GSP) is a common condition, accounting for 30–40 % of all pancreatitis cases. All GSP patients should undergo definitive treatment to prevent further attacks. This study aimed to investigate the long-term outcome after definitive treatment in England by cholecystectomy, endoscopic sphincterotomy (ES), or both.

Methods

Hospital episode statistics data were used to identify patients admitted for the first time with GSP between January and December 2005. These patients were followed for 18 months to identify those who underwent definitive treatment. Treatment groups then were followed until December 2010 to identify readmissions with a further GSP attack as an emergency or admissions with complications of gallstone disease.

Results

5,079 patients admitted with a first bout of GSP between January and December 2005. The in-hospital mortality rate was 7.8 %. Of those who survived the initial attack, 2,511 went on to have a cholecystectomy, 419 had an ES alone, and 496 had ES followed by cholecystectomy. Recurrent pancreatitis after definitive treatment was more common among patients treated with ES (6.7 %) than among those treated with cholecystectomy (4.4 %) or ES followed by cholecystectomy (1.2 %) (p < 0.05). Admissions with other complications attributable to gallstones in patients treated with ES alone were similar to those seen in patients who had received no definitive treatment (12.2 vs. 9.4 %).

Conclusions

Cholecystectomy offers better protection than ES against further bouts of pancreatitis in patients with GSP, but ES is an acceptable alternative. Interval cholecystectomy in patients treated initially with ES was the most effective method of preventing further pancreatitis, and the patients who underwent treatment by ES alone remained at risk of readmission with gallstone-related problems. Patients who have undergone ES and are fit for surgery should have a cholecystectomy.

Keywords

Gallstones Pancreatitis Cholecystectomy Endoscopic sphincterotomy 

Notes

Disclosures

Abdalla Mustafa, Irena Begaj, Mark Deakin, Damien Durkin, David J. Corless, Richard Wilson, and John P. Slavin have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Abdalla Mustafa
    • 1
    Email author
  • Irena Begaj
    • 2
  • Mark Deakin
    • 3
    • 4
  • Damien Durkin
    • 3
    • 4
  • David J. Corless
    • 1
  • Richard Wilson
    • 2
  • John P. Slavin
    • 1
    • 3
    • 4
  1. 1.Department of SurgeryMid Cheshire Hospitals NHS Foundation TrustCreweUK
  2. 2.University Hospitals NHS Foundation TrustBirminghamUK
  3. 3.Surgical Intelligence UnitUniversity of KeeleStoke on TrentUK
  4. 4.University Hospital of North StaffordshireStoke on TrentUK

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