Early Endoscopic Intervention Versus Early Conservative Management in Patients With Acute Gallstone Pancreatitis and Biliopancreatic Obstruction

Oría, Alejandro; Cimmino, Daniel G.; Ocampo, Carlos; Silva, Walter; Kohan, Gustavo; Zandalazini, Hugo; Szelagowski, Carlos; Chiappetta, Luis

doi:10.1097/01.sla.0000232539.88254.80

Cited by 150 publications

(24 citation statements)

References 29 publications

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“…Charles et al believes that all cases of suspected gallstones pancreatitis with known or suspected choledocholithiasis should undergo systematic biliary sphincterotomy [17]. In contrast, Alejandro et al reported that early endoscopic intervention failed to reduce systemic and local inflammation in patients with AGP and biliopancreatic obstruction [18]. Early endoscopic intervention is not required if acute cholangitis can be safely excluded and should not be considered a standard indication.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study

et al. 2012

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PurposeThe aim of this study was to establish enhanced recovery protocols for the management of mild gallstone pancreatitis.MethodsSixty consecutive patients were divided into enhanced recovery and traditional recovery (TR) groups in a randomized observational study. The basic enhanced recovery elements included early laparoscopic cholecystectomy, restrictive endoscopic intervention, and early oral nutrition. The incidence of complications, readmission, length of stay, and total medical cost were analyzed during the hospital course.ResultsThe length of hospital stay and medical cost were significantly lower in the enhanced recovery group in comparison to the TR group: 5.9 days vs. 10.6 days (P < 0.01) and ¥10,023 vs. ¥15,035 (P < 0.01). The complications and readmission rates in the two groups were similar.ConclusionsThe implementation of enhanced recovery protocols is feasible in the management of mild gallstone pancreatitis. The utilization of these protocols can achieve shorter hospital stays and reduced costs, with no increase in either the re-admission or peri-operative complication rates.

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Section: Discussionmentioning

confidence: 99%

Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study

et al. 2012

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“…The role of early ERCP in the context of choledocholithiasis has also been evaluated in prospective studies [ 61 , 70 - 74 ]. Amongst 153 patients in a multicenter prospective study, patients were divided into 2 groups (with and without signs of cholestasis) [ 75 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although ERCP was associated with fewer complications than the observation group (25% vs. 54%, p = 0.02) in patients with signs of cholestasis, mortality was not significantly lower (6% vs. 15%, p = 0.2). Additionally, ERCP neither reduced complications (45% vs. 41%, p = 0.8) nor mortality (14% vs. 17%, P = 0.7) in patients without cholestasis, suggesting that ERCP should be indicated only in selected patients with persistent cholestasis [ 61 , 74 ].…”

Section: Introductionmentioning

confidence: 99%

Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment

2015

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Hepatopancreatobiliary (HPB) emergencies include an ample range of conditions with overlapping clinical presentations and diverse therapeutic options. The most common etiologies are related to cholelithiasis (acute cholecystitis, pancreatitis, and cholangitis) and non-traumatic injuries (common bile duct or duodenal). Although the true incidence of HPB emergencies is difficult to determine due to selection and reporting biases, a population-based report showed a decline in the global incidence of all severe complications of cholelithiasis, primarily based on a reduction in acute cholecystitis. Even though patients may present with overlapping symptoms, treatment options can be varied. The treatment of these conditions continues to evolve and patients may require endoscopic, surgical, and/or percutaneous techniques. Thus, it is essential that a multidisciplinary team of HPB surgeons, interventional gastroenterologists and radiologists are available on an as needed basis to the Acute Care Surgeon. This focused manuscript is a contemporary review of the literature surrounding HPB emergencies in the context of the acute care surgeon. The main aim of this review is to offer an update of the diagnosis and management of HPB issues in the acute care setting to improve the care of patients with potential HPB emergencies.

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“…Previous animal and human studies suggested that duration of obstruction over 48 hours may probably result in pancreatic necrosis [ 10 – 13 ]. With regard to this point of view, any measure that can relieve ampullary obstruction as soon as possible is a crucial part in minimizing the subsequent local or systemic complications [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

Sun

Chan

Lai

et al. 2015

Gastroenterology Research and Practice

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Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD) for the treatment of acute biliary pancreatitis (ABP). Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73) were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD) in 149 patients. The mean dilating balloon size was 10.5 mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2%) adverse events and 2 (1.1%) intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease.

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Early Endoscopic Intervention Versus Early Conservative Management in Patients With Acute Gallstone Pancreatitis and Biliopancreatic Obstruction

Cited by 150 publications

References 29 publications

Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study

Enhanced recovery in the management of mild gallstone pancreatitis: a prospective cohort study

Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment

The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

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