How Does Cholecystectomy Influence Recurrence of Idiopathic Acute Pancreatitis?

Abstract

BackgroundIdiopathic acute pancreatitis is diagnosed in approximately 10–30 % of cases of acute pancreatitis. While there is evidence to suggest that the cause in many of these patients is microlithiasis, this fact has not been translated into a resource efficient treatment strategy that is proven to reduce recurrence rates. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound.MethodsThis was a retrospective study of 2236 patients who presented to a regional Australian hospital. Patients were included when diagnosed with acute pancreatitis with no confirmed cause. Recurrence of acute pancreatitis was compared between those that did and did not undergo cholecystectomy.ResultsOne hundred ninety-five consecutive patients met the study definition of “idiopathic” acute pancreatitis. 33.8 % (66/195) underwent cholecystectomy. The patients who had cholecystectomy had a recurrence rate of 19.7 % (13/66) whereas, of those managed expectantly, 42.8 % (68/159) had at least one recurrence of acute pancreatitis (P = 0.001).ConclusionsFollowing an episode of acute pancreatitis with no identifiable cause, in patients fit for surgery, cholecystectomy should be considered to reduce the risk of recurrent episodes of pancreatitis.

Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis

“…In a retrospective study comparing cholecystectomy vs follow-up in patients with IAP, the recurrence of AP was lower in cholecystectomy patients compared with follow-up (14% vs 43%; p=0.003). 27 Räty et al 28 confirmed these findings in a randomised trial reporting a recurrence rate of 14/37 in the follow-up arm vs 4/35 in the cholecystectomy arm (OR 4.7, 95% CI 1.4 to 1.6, p=0.008) with a median follow-up of 24 months. Regarding sphincterotomy, Kim et al 17 showed an absence of recurrence in 87.5% of patients with bile duct stones or sludge after sphincterotomy during a 36-month follow-up period.…”

Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis

“…Among the ten included studies, there was one RCT 8 , one cross-sectional study 20 , six prospective cohort studies 4,5,21 -24 and two 9,19 retrospective cohort studies (Table 1). The only RCT 8 compared cholecystectomy with conservative treatment in 85 patients with IAP, with an allocation ratio of 1 : 1.…”

“…Of these, 23 patients were included in one case-control study 19 and were excluded from further analyses, leaving 524 patients with 'original' IAP in the meta-analysis. Six cohorts 5,19 -21,23,24 included patients with recurrent IAP, whereas three studies 4,9,22 did not report this. Only one study 8 excluded patients with a recurrent episode of 'presumed' IAP (Table 2).…”

“…Although all studies considered cholelithiasis on imaging to be an exclusion criterion for IAP, four 19,21,23,24 did not require ultrasonography in all patients or did not mention which imaging modality was used. One study 9 included patients with raised ALT levels, and another 8 included patients with raised levels of liver enzymes, but only if MRCP was negative for CBD stones.…”

“…To reduce the risk of recurrent acute pancreatitis, same-admission cholecystectomy is advised for mild biliary pancreatitis 7 . Some studies 8,9 have advised cholecystectomy after acute pancreatitis if no other aetiology can be found implying the diagnosis of IAP during evaluation. However, the work-up for a potential biliary cause in these studies was incomplete.…”