Endoscopic Sphincterotomy and Recurrence of Acute Pancreatitis in Gallstone Patients Considered Unfit for Surgery

Abstract

The aim of the present prospective study was to investigate whether endoscopic sphincterotomy may be useful in preventing recurrence of acute pancreatitis in patients with gallstones and a high anesthesiological risk of cholecystectomy. Twenty-six elderly patients with severe cardiopulmonary, hepatic, and renal diseases were considered. Endoscopic sphincterotomy was successful in 19 cases (group A: mean age, 78.4 years; range, 71-87) and failed in 7 patients (group B: mean age, 79.8 years; range 73-85). In the follow-up period biliary pain without an increase in pancreatic serum enzymes occurred in six patients in group A and in all patients in group B (p = 0.002); recurrence of acute biliary pancreatitis with a need for hospitalization occurred in one patient in group A and in four patients in group B 0, = 0.01). These results suggest that endoscopic sphincterotomy may be considered a very useful option in reducing the recurrence of acute biliary pancreatitis in elderly patients with gallstones and a high anesthesiological risk of cholecystectomy.

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

“…Uomo et al [6] prospectively investigated the effect of ES on patients after a first attack of ABP who were considered unfit for surgery. In the ES group, the observed rate of recurrent ABP was 5% compared with 57% in the conservative group after a mean follow-up period of 30 and 23.8 months, respectively.…”

“…Recently, observational studies point toward a reduction in recurrent ABP attacks and other gallstone complications when ES is performed for selected groups of patients [6][7][8][9][10]. Based on whether a patient has undergone ES, cholecystectomy, or both, the post-ABP-status of a patient can be classified into four categories: 1 (no ES and no cholecystectomy), 2 (no ES with cholecystectomy), 3 (ES without cholecystectomy), or 4 (ES with cholecystectomy).…”

Endoscopic sphincterotomy in acute biliary pancreatitis: A question of anesthesiological risk

“…It is also important to emphasize that a substantial number of patients with 'idiopathic' pancreatitis might have small gallstones that were undetected by abdominal ultrasound or computed tomography [12] . However, a certain percentage of patients are unfit for cholecystectomy because advanced age and presence of comorbidity [13,14] .…”

“…Even if cholecystectomy is the main therapeutic option in patients with gallstones, some authors have proposed the use of ursodeoxycholic acid in order to prevent further attacks of acute pancreatitis having a biliary origin [15,16] ; others have suggested that endoscopic sphincterotomy might be an option, especially in patients considered unfit for surgery [13,14,17] . In fact, it has been suggested that endoscopic sphincterotomy is the method of choice for treatment of lithiasis of the common bile duct, particularly in elderly patients or in patients at poor operative risk [18][19][20] .…”

“…In fact, it has been suggested that endoscopic sphincterotomy is the method of choice for treatment of lithiasis of the common bile duct, particularly in elderly patients or in patients at poor operative risk [18][19][20] . This therapeutic approach has also been proposed for the management of severe acute biliary pancreatitis as a definitive procedure to avoid recurrence of the disease in patients unfit for surgery because of age or comorbidities [13,21] . However, there was a lack of follow-up data for these patients after endoscopic procedures.…”