Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis

Mador, Brett; Panton, Ormond N.M.; Hameed, S. Morad

doi:10.1007/s00464-014-3621-8

Cited by 21 publications

(10 citation statements)

References 20 publications

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“…Some retrospective studies suggested substantial risk for recurrent biliary events after discharge from hospital after an episode of ABP without undergoing cholecystectomy with reported rate between 9% and 60%. [14][15][16][17] In our study recurrent biliary events was 42% for the late group which is comparable to literatures. Some studies have supported early intervention in mild cases of ABP.…”

Section: Discussionsupporting

confidence: 91%

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Khan

et al. 2020

Int Surg J

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Background: Objective of the study was to compare the outcomes of early versus late cholecystectomy in mild to moderate acute biliary pancreatitis.Methods: This comparative prospective study was conducted at Surgical Department of Qazi Hussain Ahmed Medical Complex, Nowshera from 1st January 2018 to 31st March 2020. Patients with mild to moderate acute biliary pancreatitis (ABP) were included in the study. Patients were divided into two groups. Group 1 having patients undergoing early (operated in 7 days) and Group 2 having patients with delayed (operated after 6 weeks) laparoscopic cholecystectomy. The outcomes like hospital stay, peri and post-operative complications, recurrent cholecystitis and pancreatitis were compared. P<0.05 was considered significant.Results: A total of 300 patients were included with 150 in each group. There were 70 (46.66%) males in group 1 while group 2 consisted of 68 (45.33%) males. The median time interval of operation to the laparoscopic surgery was 5 days in group1 and 42 days in group 2. Peri operative outcomes were not significant between two groups (p=0.6). About 14 (09.63%) patients were converted to open surgery in group1 and 17 (10.53%) in group 2. Postoperative complications were also not significant between two groups (p=1.0). Group 1 had small total length of stay as compared to group 2 (p=0.006). Recurrent biliary events occurred in 63 (42.12%) patients in total with no event in group 1.Conclusions: Patients with mild to moderate ABP having early laparoscopic cholecystectomy present with reduced recurrent biliary events and the total length of hospital.

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Section: Discussionsupporting

confidence: 91%

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Khan

et al. 2020

Int Surg J

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“…12 A retrospective study of patients with mild biliary pancreatitis requiring ERCP also found a strong protective effect of early CCY compared to delayed CCY in preventing biliary complications. 13 A subsequent prospective study of patients undergoing ERCP for choledocholithiasis demonstrated that patients randomized to early (≤72 hours) CCY developed RBEs at a lower rate than patients randomized to delayed CCY (6–8 weeks after ERCP), with many patients developing interval RBE while awaiting delayed CCY. 14 Early CCY may also be important following an episode of biliary colic, and prevent unnecessary morbidity and decrease operating time.…”

Section: Introductionmentioning

confidence: 99%

Practice Patterns for Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography for Patients With Choledocholithiasis

et al. 2017

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Background & Aims Cholecystectomy (CCY) following an episode of choledocholithiasis requiring endoscopic retrograde cholangio-pancreatography (ERCP) with stone extraction reduces recurrent biliary events, compared to expectant management. We studied practice patterns for performance of CCY following ERCP for choledocholithiasis using data from 3 large states and evaluated the effects of delaying CCY. Methods We conducted a retrospective cohort study using the ambulatory surgery, inpatient, and emergency department databases from the states of California (years 2009–2011), New York (2011–2013), and Florida (2012–2014). We collected data from 4516 patients hospitalized with choledocholithiasis who underwent ERCP. We compared outcomes of patients who underwent CCY at index admission (early CCY), elective CCY within 60 days of discharge (delayed CCY), or did not undergo CCY (no CCY), calculating rate of recurrent biliary events (defined as an emergency department visit or unplanned hospitalization due to symptomatic cholelithiasis, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis), mortality, and cost by CCY cohort. We also evaluated risk factors for not undergoing CCY. The primary outcome measure was the rate of recurrent biliary events in the 365 days following discharge from index admission. Results Of the patients who underwent ERCP for choledocholithiasis, 41.2% underwent early CCY, 10.9% underwent delayed CCY, and 48.0% underwent no CCY. Early CCY reduced relative risk of recurrent biliary events within 60 days by 92%, compared with delayed or no CCY (P<.001). After 60 days following discharge from index admission, patients with early CCY had an 87% lower risk of recurrent biliary events than patients with no CCY (P<.001) and patients with delayed CCY had an 88% lower risk of recurrent biliary events than patients with no CCY (P<.001). A strategy of delayed CCY performed on an outpatient basis was least costly. Performance of early CCY was inversely associated with low facility volume. Hispanic race, Asian race, Medicaid insurance, and no insurance associated inversely with performance of delayed CCY. Conclusions In a retrospective analysis of over 4500 patients hospitalized with choledocholithiasis, we found that CCY was not performed following ERCP for almost half of the cases. Although early and delayed CCY equally reduce the risk of subsequent recurrent biliary events, patients are at 10-fold higher risk of recurrent biliary event while waiting for a delayed CCY compared with patients who underwent early CCY. Delayed CCY is a cost-effective strategy that must be balanced against the risk of loss to follow up, particularly among patients who are ethnic minorities or have little or no health insurance.

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“…The studies have shown mixed results with few shown recurrence in early and few delayed cholecystectomies but none of them have shown any significant association with this. 34,35,36 The reason of this significantly higher number with early cholecystectomy in our study is unknown. The chance of higher rate of recurrence can be improper surgery that led to remaining of the stones that were dislodged and obstructed the bile duct and led to recurrence of pancreatitis.…”

Section: Discussionmentioning

confidence: 71%

Laparoscopic Cholecystectomy;

Kamal

Akhtar

Murtaza

et al. 2018

TPMJ

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… Background: Gallstones and biliary sludge accounted for 30-55% of acute pancreatitis in the West whereas in other countries the incidence of all cases of pancreatitis amounts up to 68.5%. The risk of subsequent attacks for patients recovering from the first attack of acute biliary pancreatitis is 30-fold higher than general population. Further attacks can be prevented by cholecystectomy. Both immediate and delayed cholecystectomies are used with different degree of success and complication rates. Objectives: To compare the frequencies of complications in early and late cholecystectomy in cases of mild acute biliary pancreatitis. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical unit I Nishtar Medical College/ Hospital Multan. Duration of Study: 2 years from 1-1-2015 to 31-12-3016. Sample Size: Total 172 patients, 86 in each group. Sampling Technique: Nonprobability, consecutive sampling. Results: In this study there were total 172 cases out of which 89 (51.74%) were males and 83 (48.26%) females. The mean age was 42.02± 6.36 years and mean duration of symptoms was 4.08± 2.54 days. Mean duration of surgery was 53.30± 6.30 minutes. There were 47 males in the group undergoing early cholecystectomy and 39 in delayed with p= 0.44. Both groups had maximum cases in age group of 40-50 year with p= 0.39. There was no significant difference in terms of duration of symptoms (p=0.26) in both groups. There was significant difference in terms of prolonged duration of surgery where it was seen in 8 (9.30%) out of 86 cases with early as compared to 2 (2.33%) out of 86 cases with delayed cholecystectomy with p value of 0.05. Prolonged duration of hospital stay was also more seen in early cholecystectomy as compared to delayed one, seen in 10 (11.63) cases in early and 4 (4.65%) cases with delayed surgery in their respective groups with p= 0.09. There was significant difference (p= 0.008) in terms of per operative complication with early surgery where it affected the 18 (20.93%) cases as compared to delayed one with 6 (6.95%) cases. There was again significant difference shown in terms of recurrence of pancreatitis which was seen in 7 (8.14%) of cases with early as compared to 1 (1.16%) with delayed surgery with p= 0.03. Conclusion: Early and late cholecystectomies both are performed in tertiary care hospitals. The late cholecystectomy has shown significantly lower per operative complications, duration of surgery and chances of the recurrent pancreatitis.

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Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis

Cited by 21 publications

References 20 publications

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Cholecystectomy in mild to moderate acute biliary pancreatitis when to intervene: early versus delayed

Practice Patterns for Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography for Patients With Choledocholithiasis

Laparoscopic Cholecystectomy;

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