Factor analysis of recurrent biliary events in long‐term follow up of gallstone pancreatitis

Lee, Ji Min; Chung, Woo Chul; Sung, Hea Jung; Kim, Yeon-Ji; Youn, Gun Jung; Jung, Yun Hwa; Choi, Sooa; Jeon, Eun Jeong

doi:10.1111/1751-2980.12436

Cited by 8 publications

(7 citation statements)

References 16 publications

(40 reference statements)

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“…Even so, three out of four patients who developed biliary complications during follow-up did not have choledocholithiasis after the index episode of pancreatitis, and only 11 % of the forthcoming biliary complications were due to remaining bile duct stones. Even though the presence of bile duct stones during the index pancreatitis event has been considered an independent risk factor for recurrence (21), we did not find statistically significant differences. However, despite the fact that almost 90 % of our patients were studied for biliary tract occupation, only 70 % underwent a standard imaging test with MRCP, echoendoscopy, or ECRP.…”

Section: Discussioncontrasting

confidence: 88%

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Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Parra-Membríves¹,

García-Vico²,

Martínez-Baena³

et al. 2021

Rev Esp Enferm Dig

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Section: Discussioncontrasting

confidence: 88%

“…However, the combination of both eliminates the risk entirely, suggesting the possibility of retained lithiasis that was not discovered on imaging tests (21,22).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Parra-Membríves¹,

García-Vico²,

Martínez-Baena³

et al. 2021

Rev Esp Enferm Dig

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“…In our study, it was notable that almost half of the patients did not undergo cholecystectomy either before or after ERCP, which may be attributed to their advanced age and associated comorbidities. 17 Surprisingly, we found that having undergone cholecystectomy (either before or after ERCP) increased the risk of developing long-term benign complications. These findings contrast with what has been reported in other studies, 18 where post-ERCP cholecystectomy is associated with an overall decrease in biliopancreatic complications following ERCP.…”

Section: Discussionmentioning

confidence: 72%

Long-Term Risks of Benign and Malign Complications after Endoscopic Sphincterotomy in the Management of Benign Biliopancreatic Pathology: A Cohort Study

Ibáñez,

López,

Trujillo

et al. 2024

The Eurasian Journal of Medicine

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred technique for treating pathologies of the bile duct. It has been suggested that this procedure, combined with sphincterotomy, may influence the subsequent development of long-term complications. The main objective of this study was to determine the long-term complications of biliopancreatic disease after ERCP and their potential association with the development of biliopancreatic neoplasms. Methods: This retrospective cohort study included 576 patients who underwent ERCP (referred to as index ERCP) with sphincterotomy for benign biliary disease, with a minimum follow-up period of more than 2 years. Results: The incidence of long-term benign and neoplastic pathologies after ERCP was analyzed. The most common findings were recurrence of choledocholithiasis in 70 patients (12.1%), cholangitis “sine materia” in 27 patients (4.7%), and acute pancreatitis in 8 patients (1.4%). Eight patients (1.4%) developed hepatobiliopancreatic neoplasms, including 4 cases of pancreatic neoplasms (0.7%), 1 cholangiocarcinoma (0.2%), 1 ampulloma (0.2%), and 2 intrahepatic neoplasms (0.3%). Multivariate analysis revealed that factors such as age over 50 years, previous biliary surgery, diversion of the bile duct (BD) to the digestive tract, dilation of the BD, stent placement, biopsy, and cholecystectomy were factors associated with an increased risk of long-term benign complications. Conclusion: Endoscopic retrograde cholangiopancreatography with sphincterotomy is associated with an increased long-term risk of subsequent benign biliopancreatic disease. However, our data do not allow us to establish a direct relationship with the development of biliopancreatic neoplasms.

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“…Unlike the majority of studies evaluating the occurrence and risk of RBE and complications in delayed cholecystectomy [ 7 , 13 , 17 , 19 , 21 , 24 , 28 , 35 ], the present study rather examined the outcome in patients suffering RBE independently of the timing of surgery. Even if the occurrence of surgical complications did not reach statistical significance between groups, open cholecystectomy, either planned or converted, was significantly more frequent in patients who had RBE (Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…ERCP remains insufficient, since recurrence of CBDS occurs in up to 30% [ 4 , 14 ], and recurrence of any related biliary events (RBE) in up to 47% of the cases [ 15 , 16 ] despite clearance of the common bile duct (CBD). While ERCP fails to prevent further RBE [ 7 , 16 – 18 ], cholecystectomy does prevent the RBE in majority of the cases [ 15 , 17 , 19 , 20 ].…”

mentioning

confidence: 99%

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

Bergeron,

Doyon,

Manière

et al. 2023

Surg Endosc

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Background Gallstone disease will affect 15% of the adult population with concomitant common bile duct stone (CBDS) occurring in up to 30%. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of management for removal of CBDS, as cholecystectomy for the prevention of recurrent biliary event (RBE). RBE occurs in up to 47% if cholecystectomy is not done. The goal of this study was to evaluate the timing of occurrence of RBE after common bile duct clearance with ERCP and associated outcomes. Methods The records of all patients who underwent ERCP for gallstone disease followed by cholecystectomy, in a single center from 2010 to 2022, were reviewed. All RBE were identified. Actuarial incidence of RBE was built. Patients with and without RBE were compared. Results The study population is composed of 529 patients. Mean age was 58.0 (18–95). There were 221 RBE in 151 patients (28.5%), 39/151 (25.8%) having more than one episode. The most frequent RBE was acute cholecystitis (n = 104) followed by recurrent CBDS (n = 95). Median time for first RBE was 34 days. Actuarial incidence of RBE started from 2.5% at 7 days to reach 53.3% at 1 year. Incidence-rate of RBE was 2.9 per 100 person-months. Patients with RBE had significant longer hospitalisation time (11.7 vs 6.4 days; P < 0.0001), longer operative time (66 vs 48 min; P < 0.0001), longer postoperative stay (2.9 vs 0.9 days; P < 0.0001), higher open surgery rate (7.9% vs 1.3%; P < 0.0001), and more complicated pathology (23.8% vs 5.8%; P < 0.0001) and cholecystitis (64.2% vs 25.9%; P < 0.0001) as final diagnoses. Conclusions RBE occurred in 28.5% of the subjects at a median time of 34 days, with an incidence of 2.5% as early as 1 week. Cholecystectomy should be done preferably within 7 days after common bile duct clearance in order to prevent RBE and adverse outcomes.

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Factor analysis of recurrent biliary events in long‐term follow up of gallstone pancreatitis

Abstract: In the long-term follow up of GSP, cholecystectomy can offer better protection against recurrent biliary events than EST only. The presence of CBD stones at time of definitive therapy might be a risk factor for recurrent biliary events.

Cited by 8 publications

References 16 publications

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Long-Term Risks of Benign and Malign Complications after Endoscopic Sphincterotomy in the Management of Benign Biliopancreatic Pathology: A Cohort Study

Delay for cholecystectomy after common bile duct clearance with ERCP is just running after recurrent biliary event

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