Abstract
Background
The aim of this study was to assess whether cholecystectomy can decrease the recurrent pancreatitis in the elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) and successful clearance of bile duct (BD) stones after gallstone-related acute pancreatitis.
Methods
We analyzed data from National Health Insurance Research Database of Taiwan. Elderly patients (age ≧70 years old) who had gallstone-related acute pancreatitis and underwent successful EST with BD stones clearance were eligible for enrollment. This nationwide, population-based, propensity score (PS)-matched cohort study involved two cohorts: (1) patients who underwent cholecystectomy after ERCP with BD stone clearance as study group and (2) those who adopted wait-and-see strategy (without cholecystectomy) after ERCP with BD stone clearance as control group. The primary and secondary endpoints were recurrent acute pancreatitis and all-cause mortality, respectively.
Results
During the study period, a total of 670 elderly patients (male 291, female 379) with a mean age of 79.1 was enrolled for analysis after PS matching. The incidence rate of recurrent acute pancreatitis was 12.39 per 1000 person-years in the cholecystectomy cohort and 23.94 per 1000 person-years in the PS-matched control cohort. The risk of recurrent acute pancreatitis was significantly lower in the cholecystectomy cohort (HR, 0.56; 95 % confidence interval [CI], 0.34–0.91; P = 0.021). The HR for all-cause mortality among the cholecystectomy cohort was 0.75 (95 % CI, 0.59–0.95; P = 0.016) compared with the control cohort.
Conclusions
Cholecystectomy decreased the subsequent recurrent acute pancreatitis and the all-cause mortality in elderly patients with EST and clearance of BD stones after gallstone-related acute pancreatitis.
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Authorships
Contributions to the conception or design of the work: Shih-Hao Young, Yen-Ling Peng, and Jiing-Chyuan Luo
Acquisition, analysis, or interpretation of data for the work: Shih-Hao Young, Xi-Hsuan Lin, Yung-Tai Chen, Yen-Po Wang, Ming-Chih Hou, and Fa-Yauh Lee.
Drafting the work: Shih-Hao Young, Yen-Ling Peng, Xi-Hsuan Lin, and Jiing-Chyuan Luo.
Revising it critically for important intellectual content: Yen-Po Wang, Yung-Tai Chen, Ming-Chih Hou, and Fa-Yauh Lee.
Final approval of the version to be published: Shih-Hao Young, Xi-Hsuan Lin, Yen-Ling Peng, Jiing-Chyuan Luo, Yung-Tai Chen, Yen-Po Wang, Ming-Chih Hou, and Fa-Yauh Lee.
Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Shih-Hao Young, Yen-Ling Peng, Xi-Hsuan Lin, Yung-Tai Chen, Jiing-Chyuan Luo, Yen-Po Wang, Ming-Chih Hou, and Fa-Yauh Lee.
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This study was funded in part by grants from Taipei Veterans General Hospital (V105C-037 and V104C-019), National Science Council of Taiwan (NSC 101-2314-B-010-012-MY3), and Ministry of Science and Technology of Taiwan (MOST 104-2314-B-010-010-MY3).
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None of all authors.
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Yung-Tai Chen and Jiing-Chyuan Luo contributed equally to this work.
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Young, SH., Peng, YL., Lin, XH. et al. Cholecystectomy Reduces Recurrent Pancreatitis and Improves Survival After Endoscopic Sphincterotomy. J Gastrointest Surg 21, 294–301 (2017). https://doi.org/10.1007/s11605-016-3284-y
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DOI: https://doi.org/10.1007/s11605-016-3284-y