Gallstone Pancreatitis Without Cholecystectomy

Hwang, Stephanie S.; Li, Bonnie H.; Haigh, Philip I.

doi:10.1001/jamasurg.2013.3033

Cited by 67 publications

(54 citation statements)

References 18 publications

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“…These results are supported by several retrospective studies that also cited significantly higher recurrence rates of gallstone disease (15%-32%) in patients who did not undergo index admission cholecystectomy. [132][133][134] The majority of these recurrent attacks occurred before the time of interval cholecystectomy. 133,134 In an RCT that included 50 patients with mild acute gallstone pancreatitis, laparoscopic cholecystectomy performed within 48 hours of admission resulted in a shorter hospital stay (mean 3.…”

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

“…[132][133][134] The majority of these recurrent attacks occurred before the time of interval cholecystectomy. 133,134 In an RCT that included 50 patients with mild acute gallstone pancreatitis, laparoscopic cholecystectomy performed within 48 hours of admission resulted in a shorter hospital stay (mean 3. 135 A second study demonstrated similar findings, with a significant reduction in the mean total length of stay from 7 to 5 days (p < 0.001).…”

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

“…In a prospective study of 233 patients with acute gallstone pancreatitis, a subgroup analysis of patients discharged without undergoing cholecystectomy revealed that 37% of patients discharged with no intervention had recurrent gallstone disease within 30 days compared with 0% of patients who underwent ERCP and sphincterotomy alone (p = 0.019). 132 In a retrospective analysis of 1119 patients admitted for acute gallstone pancreatitis, Hwang and colleagues 133 reported a reduction of recurrent gallstone disease from 17% to 8% (p < 0.001) with ERCP and sphincterotomy alone, as opposed to no intervention in individuals discharged home without cholecystectomy. 133 A systematic review of 8 cohort studies and 1 RCT demonstrated a similar reduction in biliary events from 24% to 10% (p < 0.001) when patients not undergoing index admission cholecystectomy underwent ERCP and sphincterotomy before discharge.…”

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

“…132 In a retrospective analysis of 1119 patients admitted for acute gallstone pancreatitis, Hwang and colleagues 133 reported a reduction of recurrent gallstone disease from 17% to 8% (p < 0.001) with ERCP and sphincterotomy alone, as opposed to no intervention in individuals discharged home without cholecystectomy. 133 A systematic review of 8 cohort studies and 1 RCT demonstrated a similar reduction in biliary events from 24% to 10% (p < 0.001) when patients not undergoing index admission cholecystectomy underwent ERCP and sphincterotomy before discharge. 131 These data strongly support the consideration of ERCP with sphincterotomy for patients unable to tolerate surgery on the index admission owing to comorbidities or deconditioning.…”

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

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Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

327

352

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There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality. Despite the availability of clinical practice guidelines for the management of acute pancreatitis, recent studies auditing the clinical management of the condition have shown important areas of noncompliance with evidence-based recommendations. This underscores the importance of creating understandable and implementable recommendations for the diagnosis and management of acute pancreatitis. The purpose of the present guideline is to provide evidence-based recommendations for the management of both mild and severe acute pancreatitis as well as the management of complications of acute pancreatitis and of gall stone-induced pancreatitis.Une hausse de l'incidence de pancréatite aiguë a été constatée à l'échelle mondiale. Malgré l'amélioration de l'accès aux soins et aux techniques d'imagerie et d'intervention, la pancréatite aiguë est toujours associée à une morbidité et une mortalité importantes. Bien qu'il existe des guides de pratique clinique pour la prise en charge de la pancréatite aiguë, des études récentes sur la vérification de la prise en charge clinique de cette affection révèlent des lacunes importantes dans la conformité aux recommandations fondées sur des données probantes. Ces résultats mettent en relief l'importance de formuler des recommandations compréhensibles et applicables pour le diagnostic et la prise en charge de la pancréatite aiguë. La présente ligne directrice vise à fournir des recommandations fondées sur des données probantes pour la prise en charge de la pancréatite aiguë, qu'elle soit bénigne ou grave, ainsi que de ses complications et de celles de la pancréatite causée par un calcul biliaire.A cute pancreatitis can range from a mild, self-limiting disease that requires no more than supportive measures to severe disease with lifethreatening complications. The most common causes of acute pan creatitis are gallstones and binge alcohol consumption.1 There has been an increase in the incidence of acute pancreatitis reported worldwide. Despite improvements in access to care, imaging and interventional techniques, acute pancreatitis continues to be associated with significant morbidity and mortality.A systematic review of clinical practice guidelines for the management of acute pancreatitis revealed 14 guidelines published between 2004 and 2008 alone.2 Although these guidelines have significant overlap in their recommendations for diagnosing and managing acute pancreatitis, there is disagreement in some aspects of both the timing and types of interventions that should be used for both mild and severe acute pancreatitis. The availability of new imaging modalities and noninvasive therapies has also changed clinical practice. Finally, despite the availability of guidelines, recent studies auditing clinical management of acute pancreatitis have sh...

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Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

Section: Management Of Acute Gallstone Pancreatitismentioning

confidence: 99%

See 2 more Smart Citations

Clinical practice guideline: management of acute pancreatitis

Greenberg¹,

Hsu²,

Bawazeer³

et al. 2016

cjs

327

352

View full text Add to dashboard Cite

show abstract

“…In contrast, delay of cholecystectomy has been associated with the recurrence of pancreatitis in between 33% and 63% of cases and a higher rate of readmissions (18%) due to complications from the lithiasis (biliary colic, cholangitis, choledocholithiasis) (9)(10)(11).…”

mentioning

confidence: 99%

Cholecystectomy in mild acute biliary pancreatitis: The sooner; the better

Cienfuegos

Rotellar

2016

Rev Esp Enferm Dig

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Acute Pancreatitis

Mederos

Reber

Girgis

2021

JAMA

429

321

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cute pancreatitis is one of the most common gastrointestinal conditions that results in hospital admission in the United States. The incidence of acute pancreatitis is estimated at 110 to 140 per 100 000 population, with an estimated more than 300 000 US emergency department visits per year. 1,2 Admissions due to acute pancreatitis have increased from 9.48 cases per 1000 hospitalizations in 2002 to 12.19 in 2013, with a median hospital cost of nearly $7000 per hospitalization. 3,4 Acute pancreatitis is a complex disease with a variable course that is often difficult to predict early in its development (eBox in the Supplement). Approximately 80% of patients develop mild to moderately severe disease (absence of organ failure >48 hours). 5,6 However, one-fifth of patients develop severe disease, with a mortality rate of approximately 20%. 5,7 The purpose of this review is to summarize evidence regarding the recognition of disease severity, fluid and nutrition management, and risk-reduction methods for the prevention of recurrent disease. MethodsPubMed and the Cochrane databases were searched for Englishlanguage studies published from January 2009 through August 2020 for randomized clinical trials (RCTs), meta-analyses, systematic reviews, and observational studies. Manual searches were performed of the references of selected articles, reviews, metaanalyses, and practice guidelines. Select studies prior to 2009 were included for historical context. Emphasis was given to RCTs and metaanalyses. All publications and citations included were mutually agreed on by the authors and selected for clinical importance and relevance with consideration to the general medical readership of JAMA. Sixty-six articles were included, which contained 8 RCTs, 12 meta-analyses, and 5 clinical guidelines. Pathogenesis and EtiologyAcute pancreatitis is characterized by damage to the acinar cells, the functional units of the exocrine pancreas, precipitating inappropriate release and activation of trypsinogen to trypsin within the acini. This triggers the activation of other digestive enzymes, the kinin system, and the complement cascade resulting in autodigestion of the pancreatic parenchyma. 8,9 Pancreatic duct obstruction (eg, gallstone pancreatitis) is one of the more common causes of acinar damage, causing an increase in ductal pressure, interstitial edema, and accumulation of enzyme-rich fluid within the pancreatic tissue. 10 Alternatively, primary acinar injury may be caused by a variety of other factors, such as calcium, which regulates trypsin activation. Inappropriate release of IMPORTANCE In the United States, acute pancreatitis is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year. Outcomes from acute pancreatitis are influenced by risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies, which are the subject of this review.OBSERVATIONS MEDLINE was searched via PubMed as was the Cochrane data...

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Gallstone Pancreatitis Without Cholecystectomy

Abstract: In patients who did not undergo cholecystectomy, the risk of recurrent pancreatitis is significant. Endoscopic retrograde cholangiopancreatography mitigates this risk and should be considered during initial hospitalization if cholecystectomy is not done.

Cited by 67 publications

References 18 publications

Clinical practice guideline: management of acute pancreatitis

Clinical practice guideline: management of acute pancreatitis

Cholecystectomy in mild acute biliary pancreatitis: The sooner; the better

Acute Pancreatitis

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