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Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)

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Abstract

Background

UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2  weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.

Methods

All patients that presented with GSP over a 4-year period (2002–2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.

Results

100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58%) had an index cholecystectomy, and 38 (42%) an interval cholecystectomy.

Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2–30) days for index cholecystectomy and 63 (13–210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5%) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.

Conclusions

This study demonstrates that overall 62% (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.

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References

  1. Cushieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161:385–7

    Article  Google Scholar 

  2. UK guidelines for the management of acute pancreatitis (2005) UK working party on acute pancreatitis. Gut 54:1–9

    Article  Google Scholar 

  3. Senapati PSP, Battarcharaya D, Harinath G, Ammori BJ (2003) A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl 85:306–312

    Article  PubMed  CAS  Google Scholar 

  4. Yeung YP, Lam BY, Yip AW (2006) APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis. Hepatobiliary Pancreat Dis Int 5(2):294–9

    PubMed  Google Scholar 

  5. Moreau JA, Zinmeister AR, Melton LJd, Di Magno EP (1988) Gallstone pancreatitis and the effect of cholecystectomy: a population based cohort study. Mayo Clinic Proc 63:466–473

    CAS  Google Scholar 

  6. Ranson JH (1979) The timing of biliary surgery in acute pancreatitis. Ann Surg 189:654–663

    Article  PubMed  CAS  Google Scholar 

  7. Uhl W, Warshaw A, Imrie I, Bassi C (2002) International Association of Pancreatology. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2(6):565–73

    Article  PubMed  Google Scholar 

  8. Alimoglu O, Ozkan OV, Sahin M, Akcakaya A, Eryilmaz R, Bas G (2003) Timing of cholecystectomy for the acute pancreatitis: Outcome of cholecystectomy on first admission and after recurrent biliary pancreatitis. World J Surg 27:256–259

    Article  PubMed  Google Scholar 

  9. Sargen K, Kingsnorth AN (2001) Management of gallstone pancreatitis: Effects of deviation from clinical guidelines. J Pancreas 2(5):317–322

    CAS  Google Scholar 

  10. Toh SKC, Phillips S, Johnson CD (2000) A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England. Gut 46(2):239–243

    Article  PubMed  CAS  Google Scholar 

  11. Kelly TR, Wagner DS (1988) Gall stone pancreatitis: A prospective randomized trial of the timing of surgery. Surgery 104:600–604

    PubMed  CAS  Google Scholar 

  12. Nealon WH, Bawduniak J, Walser EM (2004) Appropriate timing of cholecystectomy in patients who present with moderate to severe gall stone associated acute pancreatitis with peripancreatic fluid collections. Ann Surg 239:741–751

    Article  PubMed  Google Scholar 

  13. Tondelli P, Stutz K, Harder F, Schuppisser JP, Allgower M (1982) Acute gall stone pancreatitis: best timing of biliary surgery. Br J Surg 69(12):709–710

    Article  PubMed  CAS  Google Scholar 

  14. Mayer AD, McMohan MJ, Benson EA, Axon ATR (1984) Operations upon the biliary tract in patients with acute pancreatitis: aims, indications and timing. Ann R Coll Surg 66:179–183

    CAS  Google Scholar 

  15. Ong SK, Christie PM, Windsor JA (2003) Management of gall stone pancreatitis in Auckland: progress and compliance. ANZ J Surg 73:194–199

    Article  PubMed  Google Scholar 

  16. Taylor E, Wong C (2004) The optimal timing of laparoscopic cholecystectomy in mild gall stone pancreatitis. Am Surg 70:971–75

    PubMed  Google Scholar 

  17. Griniatsos J, Karvounis E, Isla A (2005) Early versus delayed single stage laparoscopic eradication for both gall stones and common bile duct stones in mild acute biliary pancreatitis. Am Surg 71:682–686

    PubMed  Google Scholar 

  18. Stone HH, Fabian TC, Dunlop WE (1981) Gall stone pancreatitis. Biliary tract pathology in relation to time of operation. Ann Surg 194:305–310

    Article  PubMed  CAS  Google Scholar 

  19. Mofidi R,Madhavan KK,Garden OJ,Parks RW (2007) An audit of the management of patients with acute pancreatitis against national standards of practice. B J Surg Mar 2; [Epub ahead of print]

  20. Tang E, Stain SC, Tang G (1995) Timing of laparoscopic surgery in gallstone pancreatitis. Arch Surg 130:496–499

    PubMed  CAS  Google Scholar 

  21. Uhl W, Muller CA, Krahenbuhl L (1999) Acute gallstone pancreatitis: timing of cholecystectomy in mild and severe disease. Surg Endosc 13:1070–1076

    Article  PubMed  CAS  Google Scholar 

  22. Balthazar EJ (1989) CT diagnosis and staging of acute pancreatitis. Radiol Clin North Am 27:19–37

    PubMed  CAS  Google Scholar 

  23. Fan ST, Lai EC, Mok FP (1993) Early treatment of acute biliary pancreatitis with endoscopic sphincterotomy. N Engl J Med 328:228–32

    Article  PubMed  CAS  Google Scholar 

  24. Folsch UR, Nitsche R, Ludtke R (1997) Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. The German study group on acute biliary pancreatitis. N Engl J Med 336:237–42

    Article  PubMed  CAS  Google Scholar 

  25. Neoptolemos JP, Carr-Locke DL, London NJ (1988) Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gall stones. Lancet 2:979–983

    Article  PubMed  CAS  Google Scholar 

  26. Dube MG, Lobo DN, Rowlands BJ, Beckingham IJ (2001) Audit of acute pancreatitis management: a tale of 2 hospitals. J R Coll Surg Edin 46:292–6

    CAS  Google Scholar 

  27. Frey CF, Zhou H, Harvey DJ, White RH (2006) The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994–2001. Pancreas 33(4):336–44

    Article  PubMed  Google Scholar 

  28. Yadav D, Lowenfels AB (2006) Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 33(4):323–30

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ninewells Hospital and Medical School, Dundee, DD2 9SY, Scotland, UK

    Pandanaboyana Sanjay, Sim Yeeting, Carole Whigham, Hannah Judson, Francesco M. Polignano & Iain S. Tait

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  1. Pandanaboyana Sanjay
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  2. Sim Yeeting
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  3. Carole Whigham
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  4. Hannah Judson
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  5. Francesco M. Polignano
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  6. Iain S. Tait
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Corresponding author

Correspondence to Iain S. Tait.

Additional information

Presented as a poster at the Association of Surgeons of Great Britain and Ireland, Annual meeting, Manchester, 2007.

Published in abstract form P Sanjay, S Yeeting, C Whigham, H Judson, FM Polignano, IS Tait. Interval cholecystectomy is a reasonable alternative to index cholecystectomy in patients with severe gall stone pancreatitis. British Journal of Surgery; 2007; 94 (S2): 166

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Sanjay, P., Yeeting, S., Whigham, C. et al. Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP). Surg Endosc 22, 1832–1837 (2008). https://doi.org/10.1007/s00464-007-9710-1

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  • DOI: https://doi.org/10.1007/s00464-007-9710-1

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