The Role of Cholecystectomy in Reducing Recurrent Gallstone Pancreatitis

Background and Study Aim: Endoscopic sphincterotomy (ES) or cholecystectomy can prevent recurrent acute pancreatitis (RAP) in patients with gallstone-related pancreatitis. However, it is unknown whether cholecystectomy after ES offers additional benefit in preventing RAP in these patients. This is a retrospective study to assess whether cholecystectomy can decrease the incidence of RAP in patients with gallstone-related pancreatitis.
Patients and Methods: Records from 139 patients with gallstone-related pancreatitis were analyzed. Of these, 58 patients had gallbladder stones with concomitant common bile duct (CBD) stones and 81 patients had gallbladder stones without CBD stones. Of the 58 patients who had both gallbladder and CBD stones, 37 (63.8 %) did not undergo cholecystectomy after ES (group 1) and 21 patients (36.2 %) did undergo cholecystectomy after ES (group 2). Of the 81 patients who had gallbladder stones but who did not have CBD stones, 54 (66.7 %) did not undergo cholecystectomy (group 3) and 27 (33.3 %) did undergo cholecystectomy (group 4).
Results: At the time of analysis, three patients (8.1 %) in group 1 and three patients (14.3 %) in group 2 developed RAP. There was no significant difference in the estimated probability of occurrence of RAP over time between group 1 and group 2 (P = 0.41). However, there was a significantly higher probability of patients developing RAP over time in group 3 compared with group 4 (6/54 vs. 0/27 respectively, P = 0.04).
Conclusion: In patients with gallbladder stones without CBD stones, cholecystectomy can decrease the incidence of RAP. In patients with both gallbladder and CBD stones, however, the risk of RAP was not further reduced by cholecystectomy after ES and complete removal of CBD stones.

References

• 1 Opie E L. The relation of cholelithiasis to disease of the pancreas and to fat necrosis.  Am J Med Sci. 1901;  121 27-43
• 2 Howard J M, Ehrlich E W. Gallstone pancreatitis: a clinical entity.  Surgery. 1962;  51 177-184
• 3 Frei G J, Frei V T, Thirlby R C, McClelland R N. Biliary pancreatitis: clinical presentation and surgical management.  Am J Surg. 1986;  151 170-174
• 4 Gislason H, Vetrhus M, Horn A. et al . Endoscopic sphincterotomy in acute gallstone pancreatitis: a prospective study of the late outcome.  Eur J Surg. 2001;  167 204-208
• 5 Hammarstrom L E, Stridbeck H, Ihse I. Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis.  Br J Surg. 1998;  85 333-336
• 6 Kaw M, Al-Antably Y, Kaw P. Management of gallstone pancreatitis: cholecystectomy or ERCP and endoscopic sphincterotomy.  Gastrointest Endosc. 2002;  56 61-65
• 7 Oria A, Alvarez J, Chiappetta L. et al . Choledocholithiasis in acute gallstone pancreatitis. Incidence and clinical significance.  Arch Surg. 1991;  126 566-568
• 8 Graham D F, Wyllie F J. Prediction of gallstone pancreatitis by computer.  BMJ. 1979;  1 515-517
• 9 Safrany L, Cotton P B. A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis.  Surgery. 1981;  89 424-428
• 10 Folsch U R, Nitsche R, Ludtkew R. et al . German study group on acute biliary pancreatitis. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis.  N Eng J Med. 1997;  336 237-242
• 11 Liu C L, Lo C M, Chan J K. et al . Detection of choledocholithiasis by EUS in acute pancreatitis: a prospective evaluation in 100 consecutive patients.  Gastrointest Endosc. 2001;  54 325-330
• 12 Fan S T, Lai E C, Mok F P. et al . Early treatment of acute biliary pancreatitis by endoscopic papillotomy.  N Eng J Med. 1993;  328 228-232
• 13 Wilson P G, Neoptolemos J P. Gallstone-associated acute pancreatitis. In: Howard J, Idezuki Y, Ihse I, Prinz R (eds) Surgical diseases of the pancreas, 3rd edn. Baltimore; Williams & Wilkins 1998: 240-245
• 14 Windsor J A. Gallstone pancreatitis: a proposed management strategy.  Aust NZ J Surg. 1990;  60 589-594
• 15 Appelros S, Borgstrom A. Incidence, aetiology and mortality rates of acute pancreatitis over 10 years in a defined urban population in Sweden.  Br J Surg. 1999;  86 465-470
• 16 Toouli J, Brooke-Smith M, Bassi C. et al . Guidelines for the management of acute pancreatitis.  J Gastroenterol & Hepatol. 2002;  17 (Suppl) S15-S39
• 17 Lam S K, Wong K P, Chan P KW. et al . Recurrent pyogenic cholangitis: a study by endoscopic retrograde cholangiography.  Gastroenterology. 1978;  74 1196-1203