Endoscopic sphincterotomy without cholecystectomy for gall stone pancreatitis.

Welbourn, C. R. B.; Beckly, D.E.; Eyre‐Brook, I. A.

doi:10.1136/gut.37.1.119

Cited by 81 publications

(57 citation statements)

References 9 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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“…Many authors have advocated a wait-and-see policy after ES for these patients because only an estimated 10% of them experience recurrent biliary symptoms in retrospective and nonrandomized studies [4][5][6][7][8]. However, in two prospective randomized trials, up to 47% of the patients presented with recurrent biliary symptoms after a wait-and-see policy, and the cumulative risk for death was 21% within 5 years (vs 5.8% for patients allocated to planned cholecystectomy) [9,10].…”

mentioning

confidence: 99%

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

et al. 2008

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Background According to the literature, the conversion rate for laparoscopic cholecystectomy (LC) after endoscopic sphincterotomy (ES) for cholecystodocholithiasis reaches 20%, at least when LC is performed 6 to 8 weeks afterward. It is hypothesized that early planned LC after ES prevents recurrent biliary complications and reduces operative morbidity and hospital stay. Methods All consecutive patients who underwent LC after ES between 2001 and 2004 were retrospectively evaluated. Recurrent biliary complications during the waiting time for LC, conversion rate, postoperative complications, and hospital stay were documented. Results This study analyzed 167 consecutive patients (59 men) with a median age of 54 years. The median interval between ES and LC was 7 weeks (range, 1-49 weeks). During the waiting time for LC, 33 patients (20%) had recurrent biliary complications including cholecystitis (n = 18, 11%), recurrent choledocholithiasis (n = 9, 5%), cholangitis (n = 4, 2%), and biliary pancreatitis (n = 2, 1%). Of these 33 patients, 15 underwent a second endoscopic retrograde cholangiography (ERC). The median time between ES and the development of recurrent complications was 22 days (range, 3-225 days). Most of the biliary complications (76%) occurred more than 1 week after ES. Conversion to open cholecystectomy occurred for 7 of 33 patients with recurrent complications during the waiting period, compared with 13 of 134 patients with an uncomplicated waiting period (p = 0.14). This concurred with doubled postoperative morbidity (24% vs 11%; p = 0.09) and a longer hospital stay (median, 4 vs 2 days; p \ 0.001). Conclusion In this retrospective analysis, 20% of all patients had recurrent biliary complications during the waiting period for cholecystectomy after ES. These recurrent complications were associated with a significantly longer hospital stay. Cholecystectomy within 1 week after ES may prevent recurrent biliary complications in the majority of cases and reduce the postoperative hospital stay.Keywords Biliary complications Á Cholecystectomy Á Common bile duct Á Conversion rate Á Endoscopic sphincterotomyOf the patients presenting with cholecystolithiasis, 4% to 15% have concomitant common bile duct (CBD) stones [1][2][3]. The current standard of treatment for symptomatic

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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%