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
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.
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.
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%).
In patient with non-severe ABP, ES is an alternative to reduce recurrent ABP, however without EC, future cholecystitis may still develop.
KeywordsAcute biliary pancreatitis Endoscopic sphincterotomy Cholecystectomy
Acute biliary pancreatitis
The American College of Gastroenterology
The American Gastroenterological Association Institute
Endoscopic retrograde cholangiopancreatography
Common bile duct
Charlson Comorbidity Index
The United Kingdom
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).
Compliance with ethical standards
Drs. Wiriyaporn Ridtitid, Santi Kulpatcharapong, Panida Piyachaturawat, Phonthep Angsuwatcharakon, Pradermchai Kongkam, and Rungsun Rerknimitr have no conflicts of interest or financial ties to disclose.
- 1.Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Büchler MW (2002) IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573CrossRefGoogle Scholar
- 6.Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland (2005) UK guidelines for the management of acute pancreatitis. Gut 54:iii1–9Google Scholar
- 10.da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, Bakker OJ, Bollen TL, Dejong CH, van Goor H, Boermeester MA, Bruno MJ, van Eijck CH, Timmer R, Weusten BL, Consten EC, Brink MA, Spanier BWM, Bilgen EJS, Nieuwenhuijs VB, Hofker HS, Rosman C, Voorburg AM, Bosscha K, van Duijvendijk P, Gerritsen JJ, Heisterkamp J, de Hingh IH, Witteman BJ, Kruyt PM, Scheepers JJ, Molenaar IQ, Schaapherder AF, Manusama ER, van der Waaij LA, van Unen J, Dijkgraaf MG, van Ramshorst B, Gooszen HG, Boerma D (2015) Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 386:1261–1268CrossRefGoogle Scholar
- 14.Sargen K, Kingsnorth AN (2001) Management of gallstone pancreatitis: effects of deviation from clinical guidelines. JOP 2:317–322Google Scholar
- 35.Kahaleh M, Hall JD, Kohli A, Alaguero CC, Ferre SA, De La Rue SA, Friel CM, Eugene FF, Northup JC, Adams RB, Yeaton P (2007) Does cholecystectomy protect from recurrent gallstone pancreatitis after biliary sphincterotomy? A prospective study. Gastrointest Endosc 65:AB223Google Scholar