Endoscopic sphincterotomy for biliary pancreatitis: An alternative to cholecystectomy in high-risk patients

Siegel, Jerome H.; Veerappan, Annamali; Cohen, Seth A.; Kasmin, Franklin

doi:10.1016/s0016-5107(94)70255-1

Cited by 85 publications

(47 citation statements)

References 18 publications

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“…Biliary sphincterotomy rather than cholecystectomy may be appropriate for proven mild biliary pancreatitis, especially in elderly patients who are poor candidates for surgery because of severe medical comorbidity, patients in whom cholecystectomy must be delayed because of local or systemic complications of pancreatitis, or because of pregnancy (255)(256)(257)(258). The role of biliary sphincterotomy when biliary pancreatitis is strongly suspected but not proven has not been fully characterized.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

“…Some studies have suggested the effectiveness of endoscopic biliary sphincterotomy in these circumstances in preventing further episodes of acute biliary pancreatitis. These uncontrolled case series mostly suggest a reduction in the frequency of attacks of pancreatitis, although recurrent bile duct stones or acute cholecystitis may still be a problem in the future (255)(256)(257)(258)(259)(260)(261)(262)(263)(264). Before considering an empiric biliary sphincterotomy for recurrent pancreatitis with or without abnormal liver function tests, the clinician must be aware of the possibility of an alternative etiology, such as sphincter of Oddi dysfunction, especially in women, young or middleaged patients, and patients who are postcholecystectomy, or do not have clearly documented gallstone disease.…”

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

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Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

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Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Section: Treatment Guideline Vii: Role Of Ercp and Biliary Sphincteromentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

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“…(Table 1) EUS also has the advantage of evaluating several alternative causes for AIP including pancreas divisum, neoplasms, and undiagnosed chronic pancreatitis [10] . T herapy for microlithiasis/sludg e is g enerally laparoscopic cholecystectomy although endoscopic biliary sphincterotomy in the poor operative candidate [11] or longterm treatment with ursodeoxycholic acid [3] are alternatives.…”

Section: Gallbladder In Situmentioning

confidence: 99%

Sphincter of Oddi dysfunction and bile duct microlithiasis in acute idiopathic pancreatitis

Elta

2008

WJG

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Although there are numerous causes of acute pancreatitis, an etiology cannot always be found. Two potential etiologies, microlithiasis and sphincter of Oddi dysfunction, are discussed in this review. Gallbladder microlithiasis, missed on transcutaneous ultrasound, is reported as the cause of idiopathic acute pancreatitis in a wide frequency range of 6%-80%. The best diagnostic technique for gallbladder microlithiasis is endoscopic ultrasound although biliary crystal analysis and empiric cholecystectomy remain as reasonable options. In contrast, in patients who are post-cholecystectomy, bile duct microlithiasis does not appear to have a role in the pathogenesis of acute pancreatitis. Sphincter of Oddi dysfunction is present in 30%-65% of patients with idiopathic acute recurrent pancreatitis in whom other diagnoses have been excluded. It is unclear if this sphincter dysfunction was the original etiology of the first episode of pancreatitis although it appears to have a causative role in recurring episodes since sphincter ablation decreases the frequency of recurrent attacks. Unfortunately, this conclusion is primarily based on small retrospective case series; larger prospective studies of the outcome of pancreatic sphincterotomy for SOD-associated acute pancreatitis are sorely needed. Another problem with this diagnosis and its treatment is the concern over potential procedure related complications from endoscopic retrograde cholangiopancreatography (ERCP), manometry and pancreatic sphincterotomy. For these reasons, patients should have recurrent acute pancreatitis, not a single episode, and have a careful informed consent before assessment of the sphincter of Oddi is undertaken.

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“…Microlithiasis may lead to pancreatitis through several mechanisms: transient impaction of small stones at the papilla, obstructing the pancreatic duct, or the repeated passage of stones (which may lead to papillary stenosis or SOD, both of which are associated with pancreatitis) [14] . Surgical or endoscopic treatment of occult microlithiasis significantly reduces the recurrent episodes of acute pancreatitis compared with untreated patients [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Three recent studies maintain that EUS should replace ERCP as the first procedure in patients with mild to moderate acute pancreatitis to avoid unnecessary ERCP and thus reduce ERCP-induced morbidity [22][23][24] .…”

Section: Microlithiasismentioning

confidence: 99%