Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

Abstract

Endoscopic sphincterotomy is a safe and acceptable alternative to cholecystectomy for the prevention of recurring attacks of gallstone pancreatitis. As a result of this procedure, 75% of patients remained free of symptoms in the long term.

ERCP and Endoscopic Sphincterotomy (ES): A Safe and Definitive Management of Gallstone Pancreatitis with the Gallbladder Left In Situ

“…The results of this study demonstrate ERCP and ES to be an effective treatment to prevent recurrence of pancreatitis secondary to gallstones with a low complication rate. The recurrence rate of pancreatitis of 6% is higher than the results published by Vazquez-Iglesias, 13 Welbourn, 14 and Lee 15 who quote figures of 2%, 0% and 0%, respectively. The discrepancy between the published data is most likely due to the small numbers and short follow-up by Welbourn and Lee since two of our recurrences occurred at 24 and 60 months.…”

“…The discrepancy between the published data is most likely due to the small numbers and short follow-up by Welbourn and Lee since two of our recurrences occurred at 24 and 60 months. The presence of fibrosis following ES is named as a cause of recurrence of pancreatitis, 13,14 but in those cases in this study where a further ERCP was undertaken, there was no evidence of fibrosis to explain the recurrence. All patients in this study had documented evidence of gallstones, either radiologically or at ERCP, but at recurrence, there were no common bile duct (CBD) stones on repeat ERCP which revealed a dilated CBD in only one patient.…”

“…The median length of stay of patients following ERCP was 2 days (range, 1-49; IQR, 1-7) with a median total length of stay of 11.5 days (range, 4-85; IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20]. One ERCP and ES was complicated by pancreatitis post-procedure which extended the hospital stay by 30 days.…”

“…12 In an ageing population with increased comorbidities however, this treatment is not always appropriate. ERCP and sphincterotomy alone has been shown to be effective in the prevention of gallstone pancreatitis, and this has increasingly been used in the elderly and frail, [13][14][15] but these studies are often limited by small patient numbers or short duration of follow-up. Only the study by Vazquez- Iglesias et al 13 which followed up 88 patients over a median follow-up period of 51 months supports the longterm effectiveness of this strategy.…”

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

“…However, Hammarstrom et al [8] observed a 12.5% rate of ABP recurrence in noncholecystectomized patients during a median follow-up period of 79 months. Other prospective observational studies with various follow-up times showed ABP recurrence rates of 0.9% to 6.4% for patients treated with ES alone [7,8,[22][23][24].…”