Korean J Gastroenterol.  2015 May;65(5):297-305. 10.4166/kjg.2015.65.5.297.

Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis?

• Bang KB
• Kim HJ
• Cho YK
• Jeon WK

• KMID: 2373226
• DOI: http://doi.org/10.4166/kjg.2015.65.5.297

Abstract

BACKGROUND/AIMS
Practice guidelines from international societies have recommended cholecystectomy during the same hospitalization for acute biliary pancreatitis (ABP). The aim of this study is to investigate the question of whether endoscopic sphincterotomy (EST) and/or cholecystectomy during the same hospitalization can reduce the recurrence rate of ABP.
METHODS
A total of 119 patients with ABP admitted to our institution between May 2005 and May 2010 who had complete follow-up data until May 2012 were enrolled.
RESULTS
No significant differences in initial CT severity index and Charlson comorbidity index were observed between EST (n=64) and non-EST group (n=55) and among subgroups classified according to interventions performed. In Kaplan-Meier analyses, significantly higher recurrence rates of ABP were observed in the non-EST group compared to the EST group (p<0.01), and in the conservative treatment group compared to other intervention groups (p<0.01). The frequency of complications from ABP was significantly higher in the conservative treatment group (35.7%) and lowest in the EST plus cholecystectomy group (5.0%, p=0.008). In multivariate analysis, conservative treatment without EST and/or cholecystectomy, and non-EST group were independent risk factors for recurrence after the initial attack of ABP.
CONCLUSIONS
ERCP with EST and cholecystectomy during the index admission is associated with reduced recurrence rates of ABP.

Keyword

Acute biliary pancreatitis; Recurrence; Endoscopic sphincterotomy; Cholecystectomy

MeSH Terms

Acute Disease
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy, Laparoscopic
Cohort Studies
Female
Follow-Up Studies
Humans
Length of Stay
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Pancreatitis/*pathology/surgery
Recurrence
Retrospective Studies
Severity of Illness Index
Sphincterotomy, Endoscopic
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1. The process for selection of our enrolled patients.

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  Fig. 2. Fifteen patients (12.6%) experienced recurrences of acute biliary pancreatitis (ABP) during the follow-up period. By Kaplan-Meier analyses with log rank comparison, recurrence rates of ABP were significantly higher in the non-endoscopic sphincterotomy (EST) group compared to the EST group (p<0.01), and in the conservative treatment group compared to other intervention groups by log rank comparisons (p<0.01). CBD, common bile duct.

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  Fig. 3. (A) Time to recovery from ABP (days) was significantly longer in the non-endoscopic sphincterotomy (EST) group compared to the EST group (5.0±3.0 vs. 2.4±1.3; p<0.001). (B) Among the groups of patients classified according to the interventions performed, the conservative treatment group and cholecystectomy only group were associated with significantly longer recovery time from ABP (days) compared with the EST plus cholecystectomy group and EST only group by post hoc tests (5.4±3.9 and 4.8±2.7 vs. 2.2±1.0 and 2.8±1.6, respectively; p<0.01). (C) The length of hospital stay (days) was significantly longer in the non-EST group compared to the EST group (15.0±22.8 vs. 4.4±2.2, respectively; p<0.01). (D) By post hoc tests, the conservative treatment group and cholecystectomy only group were associated with significantly longer hospital stay (days) compared with the EST plus cholecystectomy group and EST only group (15.1±14.6 and 15.0±25.1 vs.3.8±1.4 and 5.4±2.8, respectively; p<0.01).

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  Fig. 4. Complication rates. (A) Three patients (4.7%) in the endoscopic sphincterotomy (EST) group and 11 patients (20.0%) in the non-EST group experienced complications of acute biliary pancreatitis (ABP) defined in the current study. Significantly higher occurrence rates of complications of ABP were observed in the non-EST group compared to the EST group (p=0.02). (B) Significantly higher complications rates were observed in the conservative treatment group (35.7%) and the lowest in the EST plus cholecystectomy group (5.0%, p=0.008).

Reference

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