Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta‐Analysis

Prasanth, Jayaraj; Prasad, Manya; Mahapatra, Soumya Jagannath; Krishna, Asuri; Prakash, Om; Garg, Pramod Kumar; Bansal, Virinder Kumar

doi:10.1007/s00268-022-06501-4

Cited by 22 publications

(15 citation statements)

References 37 publications

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“…27 Consistent with findings of previous studies, our results highlighted that performing cholecystectomy significantly reduced the risk of recurrent pancreatitis after first attack of gallstone pancreatitis. Prasanth et al 58 conducted a meta-analysis of 11 randomized controlled trials and concluded that early cholecystectomy has definite advantages in terms of reducing recurrent pancreaticobiliary events and length of hospital stay after gallstone pancreatitis. 58 A recent meta-analysis conducted by Umans et al 59 showed that cholecystectomy after idiopathic acute pancreatitis may also reduce the risk of recurrent pancreatitis and argued that current diagnostics are insufficient to exclude a biliary cause in this setting.…”

Section: Discussionmentioning

confidence: 99%

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The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta‐analysis and meta‐regression analysis

Hajibandeh

Jurdon

Heaton

et al. 2023

J of Gastro and Hepatol

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Background and AimThe study aims to determine and quantify the stratified risk of recurrent pancreatitis (RP) after the first episode of acute pancreatitis in relation to etiology and severity of disease.MethodsA systematic review and meta‐analysis in compliance with PRISMA statement standards was conducted. A search of electronic information sources was conducted to identify all studies investigating the risk of RP after the first episode of acute pancreatitis. Proportion meta‐analysis models using random effects were constructed to calculate the weighted summary risks of RP. Meta‐regression was performed to evaluate the effect of different variables on the pooled outcomes.ResultsAnalysis of 57,815 patients from 42 studies showed that the risk of RP after first episode was 19.8% (95% confidence interval [CI] 17.5–22.1%). The risk of RP was 11.9% (10.2–13.5%) after gallstone pancreatitis, 28.7% (23.5–33.9%) after alcohol‐induced pancreatitis, 30.3% (15.5–45.0%) after hyperlipidemia‐induced pancreatitis, 38.1% (28.9–47.3%) after autoimmune pancreatitis, 15.1% (11.6–18.6%) after idiopathic pancreatitis, 22.0% (16.9–27.1%) after mild pancreatitis, 23.9% (12.9–34.8%) after moderate pancreatitis, 21.6% (14.6–28.7%) after severe pancreatitis, and 6.6% (4.1–9.2%) after cholecystectomy following gallstone pancreatitis. Meta‐regression confirmed that the results were not affected by the year of study (P = 0.541), sample size (P = 0.064), length of follow‐up (P = 0.348), and age of patients (P = 0.138) in the included studies.ConclusionsThe risk of RP after the first episode of acute pancreatitis seems to be affected by the etiology of pancreatitis but not the severity of disease. The risks seem to be higher in patients with autoimmune pancreatitis, hyperlipidemia‐induced pancreatitis, and alcohol‐induced pancreatitis and lower in patients with gallstone pancreatitis and idiopathic pancreatitis.

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Section: Discussionmentioning

confidence: 99%

“…Prasanth et al 58 . conducted a meta‐analysis of 11 randomized controlled trials and concluded that early cholecystectomy has definite advantages in terms of reducing recurrent pancreaticobiliary events and length of hospital stay after gallstone pancreatitis 58 . A recent meta‐analysis conducted by Umans et al 59 .…”

Section: Discussionmentioning

confidence: 99%

The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta‐analysis and meta‐regression analysis

Hajibandeh

Jurdon

Heaton

et al. 2023

J of Gastro and Hepatol

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“…The absence of high-quality data on patients with moderately severe and severe ABP makes it challenging to provide a conclusive recommendation regarding the ideal timing for cholecystectomy in this subgroup of patients. A recent metaanalysis by Prasanth et al 21 did not identify enough patients with moderately severe and severe ABP to perform a subgroup analysis assessing the effect of the timing of cholecystectomy in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, whether a same-admission or early cholecystectomy (EC) should be indicated in patients with moderately severe and severe ABP is still debatable. There are conflicting data, 5,20,21 based on a few small retrospective studies, [22][23][24][25][26][27][28] as reflected by a previous systematic review of current guidelines, 29 which demonstrated that current recommendations are based on a quality of evidence not above level 2C, according to the Oxford Centre for Evidence-Based Medicine. 30 Therefore, considering the lack of equipoise on the timing of cholecystectomy in patients with moderately severe and severe ABP, it is critical to assess the safety and outcomes of EC in such patients.…”

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confidence: 99%

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Di Martino,

Ielpo,

Pata

et al. 2023

JAMA Surg

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ImportanceConsidering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.ObjectiveTo assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.Design, Settings, and ParticipantsThis cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.Main OutcomesMortality and morbidity after EC.ResultsOf the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P &lt; .001) and morbidity (7.7% vs 3.7%, P &lt; .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P &lt; .001), morbidity (30 [30.3%] vs 57 [5.5%], P &lt; .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P &lt; .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P &lt; .001), morbidity (30 [30.3%] vs 17 [10.3%], P &lt; .001), and infections (12 [14.6%] vs 2 [1.3%], P &lt; .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient’s age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).Conclusions and RelevanceThis cohort study’s findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC.

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“…Dear Editor, I read with interest Jayaraj et al's systematic review and meta-analysis on Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis [1].…”

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Letter to the Editor: Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta‐Analysis

Dadhwal¹

2022

World j. surg.

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Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta‐Analysis

Cited by 22 publications

References 37 publications

The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta‐analysis and meta‐regression analysis

The risk of recurrent pancreatitis after first episode of acute pancreatitis in relation to etiology and severity of disease: A systematic review, meta‐analysis and meta‐regression analysis

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

Letter to the Editor: Early Versus Delayed Cholecystectomy for Acute Biliary Pancreatitis: A Systematic Review and Meta‐Analysis

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