Korean J Gastrointest Endosc.  2006 Sep;33(3):152-158.

The Roles of Endoscopic Sphincterotomy and Cholecystectomy in Acute Biliary Pancreatitis

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Korea. jkryu@snu.ac.kr
  • 2Liver Research Institute, Seoul National University Boramae Hospital, Seoul, Korea.
  • 3Seoul National University Bundang Hospital, Bundang, Korea.
  • 4Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea.

Abstract

BACKGROUND/AIMS: Stone removal can prevent recurrence of acute biliary pancreatitis. This study examined the natural course of acute biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy. In addition, the incidence and risk factors associated with acute cholecystitis were estimated when a cholecystectomy had not been performed.
METHODS
The medical records of 113 patients diagnosed with acute biliary pancreatitis in Seoul National University Hospital from January 1990 to April 2005 were reviewed retrospectively.
RESULTS
Twenty-five patients received no specific treatment of which 15 (60.0%) experienced a recurrence during a mean follow-up period of 36.0 months. Fifty-two patients received EST only and did not experience a recurrence during a mean follow-up of 29.8 months. Thirty-six patients underwent a cholecystectomy, and 1 (2.8%) patient experienced a second attack during a follow-up of 35.2 months. The clinical factors predictive of pancreatitis recurrence in patients without treatment could not be identified. Acute cholecystitis developed in 7 out of 77 (9.1%) patients who did not receive a cholecystectomy during a mean follow-up period of 33.3 months, and patients with both gallbladdor and common bile duct stones were found to be more prone to a recurrence.
CONCLUSIONS
Sixty percent of patients with acute biliary pancreatitis without treatment experienced a second attack, which could be prevented by EST. A cholecystectomy is not always necessary as a routine treatment after EST for preventing pancreatitis, and is recommended for patients with both visible gallbladdor and common bile duct stones at the time of the first attack.

Keyword

Acute pancreatitis; Cholelithiasis; Choledocholithiasis; Acute cholecystitis; Cholecystectomy
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