Comparative study of early versus delayed laparoscopic cholecystectomy following endoscopic sphincterotomy for mild to moderate acute biliary pancreatitis.
EAES Academy. DEVKARAN B. 07/05/22; 363040; P084
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Abstract
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Introduction:
Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases and elective cholecystectomy has long been recommended for patients with acute gallstone pancreatitis. Current recommendations however favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks which have been reported to be as high as 18-61% in various studies with 4-50% being severe recurrent attacks. ERCP with endoscopic sphincterotomy (ES) is established as an initial treatment for severe acute gallstone pancreatitis and has been shown to reduce the complication rate, morbidity, and mortality for selected patients but there are no recommendations for mild and moderate cases. Endoscopic sphincterotomy in these cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity.
Methods:
A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups. In group A, 19 patients underwent LC within 5 days of admission. In group B, 19 patients underwent ES within 7 days of onset of pain abdomen and had LC within 4 weeks of initial illness. In group C, 19 patients after being managed conservatively initially underwent LC after 8 weeks of attack. These groups were evaluated for level of difficulty of cholecystectomy, recurrent attacks of pancreatitis and associated morbidity.
Results:
All patients had mild to moderate pancreatitis with a CT severity score of less than 6. In Group A, all patients underwent laparoscopic cholecystectomy within 10 days of admission. Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks. Hospital stay in group A ranged from 1-5 days (2.37±1.11), in group B, from 4-11 days (6.47±2.01) and in group C, from 5-15 days (8.05±2.41) days.
Conclusion:
LC in early period is a safe, effective, and feasible in patients of gallstone induced pancreatitis. ES is well tolerated and is a viable alternative to cholecystectomy in high surgical risk patients for the prevention of recurrent pancreatitis till the time of definitive treatment in the form of LC for ABP.
Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases and elective cholecystectomy has long been recommended for patients with acute gallstone pancreatitis. Current recommendations however favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks which have been reported to be as high as 18-61% in various studies with 4-50% being severe recurrent attacks. ERCP with endoscopic sphincterotomy (ES) is established as an initial treatment for severe acute gallstone pancreatitis and has been shown to reduce the complication rate, morbidity, and mortality for selected patients but there are no recommendations for mild and moderate cases. Endoscopic sphincterotomy in these cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity.
Methods:
A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups. In group A, 19 patients underwent LC within 5 days of admission. In group B, 19 patients underwent ES within 7 days of onset of pain abdomen and had LC within 4 weeks of initial illness. In group C, 19 patients after being managed conservatively initially underwent LC after 8 weeks of attack. These groups were evaluated for level of difficulty of cholecystectomy, recurrent attacks of pancreatitis and associated morbidity.
Results:
All patients had mild to moderate pancreatitis with a CT severity score of less than 6. In Group A, all patients underwent laparoscopic cholecystectomy within 10 days of admission. Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks. Hospital stay in group A ranged from 1-5 days (2.37±1.11), in group B, from 4-11 days (6.47±2.01) and in group C, from 5-15 days (8.05±2.41) days.
Conclusion:
LC in early period is a safe, effective, and feasible in patients of gallstone induced pancreatitis. ES is well tolerated and is a viable alternative to cholecystectomy in high surgical risk patients for the prevention of recurrent pancreatitis till the time of definitive treatment in the form of LC for ABP.
Introduction:
Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases and elective cholecystectomy has long been recommended for patients with acute gallstone pancreatitis. Current recommendations however favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks which have been reported to be as high as 18-61% in various studies with 4-50% being severe recurrent attacks. ERCP with endoscopic sphincterotomy (ES) is established as an initial treatment for severe acute gallstone pancreatitis and has been shown to reduce the complication rate, morbidity, and mortality for selected patients but there are no recommendations for mild and moderate cases. Endoscopic sphincterotomy in these cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity.
Methods:
A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups. In group A, 19 patients underwent LC within 5 days of admission. In group B, 19 patients underwent ES within 7 days of onset of pain abdomen and had LC within 4 weeks of initial illness. In group C, 19 patients after being managed conservatively initially underwent LC after 8 weeks of attack. These groups were evaluated for level of difficulty of cholecystectomy, recurrent attacks of pancreatitis and associated morbidity.
Results:
All patients had mild to moderate pancreatitis with a CT severity score of less than 6. In Group A, all patients underwent laparoscopic cholecystectomy within 10 days of admission. Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks. Hospital stay in group A ranged from 1-5 days (2.37±1.11), in group B, from 4-11 days (6.47±2.01) and in group C, from 5-15 days (8.05±2.41) days.
Conclusion:
LC in early period is a safe, effective, and feasible in patients of gallstone induced pancreatitis. ES is well tolerated and is a viable alternative to cholecystectomy in high surgical risk patients for the prevention of recurrent pancreatitis till the time of definitive treatment in the form of LC for ABP.
Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases and elective cholecystectomy has long been recommended for patients with acute gallstone pancreatitis. Current recommendations however favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks which have been reported to be as high as 18-61% in various studies with 4-50% being severe recurrent attacks. ERCP with endoscopic sphincterotomy (ES) is established as an initial treatment for severe acute gallstone pancreatitis and has been shown to reduce the complication rate, morbidity, and mortality for selected patients but there are no recommendations for mild and moderate cases. Endoscopic sphincterotomy in these cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity.
Methods:
A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups. In group A, 19 patients underwent LC within 5 days of admission. In group B, 19 patients underwent ES within 7 days of onset of pain abdomen and had LC within 4 weeks of initial illness. In group C, 19 patients after being managed conservatively initially underwent LC after 8 weeks of attack. These groups were evaluated for level of difficulty of cholecystectomy, recurrent attacks of pancreatitis and associated morbidity.
Results:
All patients had mild to moderate pancreatitis with a CT severity score of less than 6. In Group A, all patients underwent laparoscopic cholecystectomy within 10 days of admission. Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks. Hospital stay in group A ranged from 1-5 days (2.37±1.11), in group B, from 4-11 days (6.47±2.01) and in group C, from 5-15 days (8.05±2.41) days.
Conclusion:
LC in early period is a safe, effective, and feasible in patients of gallstone induced pancreatitis. ES is well tolerated and is a viable alternative to cholecystectomy in high surgical risk patients for the prevention of recurrent pancreatitis till the time of definitive treatment in the form of LC for ABP.
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