Indications for endoscopic retrograde cholangiopancreatography and cholecystectomy in biliary pancreatitis

Schulz, Christian; Schirra, Jörg; Mayerle, Julia

doi:10.1002/bjs.11402

Cited by 4 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From these studies, one can conclude that urgent ERCP is indicated for acute GSP when concomitant cholangitis is suspected or in the presence of obstructive jaundice (total bilirubin level, >4 mg/dL). In the absence of these indications, ERCP generally offers no clinical benefit in patients with isolated GSP …”

Section: Discussion and Observationsmentioning

confidence: 99%

“…Early preoperative ERCP is indicated when concomitant cholangitis is suspected or in the presence of obstructive jaundice (total bilirubin level, >4 mg/dL). In the absence of these indications, the benefit of preoperative ERCP is uncertain …”

Section: Discussionmentioning

confidence: 99%

“…In the absence of these indications, ERCP generally offers no clinical benefit in patients with isolated GSP. 55…”

Section: Identification and Management Of Suspected Cbd Stonesmentioning

confidence: 99%

See 2 more Smart Citations

Management of Gallstone Pancreatitis

McDermott,

Kao,

Keeley

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

ImportanceGallstone pancreatitis (GSP) is the leading cause of acute pancreatitis, accounting for approximately 50% of cases. Without appropriate and timely treatment, patients are at increased risk of disease progression and recurrence. While there is increasing consensus among guidelines for the management of mild GSP, adherence to these guidelines remains poor. In addition, there is minimal evidence to guide clinicians in the treatment of moderately severe and severe pancreatitis.ObservationsThe management of GSP continues to evolve and is dependent on severity of acute pancreatitis and concomitant biliary diagnoses. Across the spectrum of severity, there is evidence that goal-directed, moderate fluid resuscitation decreases the risk of fluid overload and mortality compared with aggressive resuscitation. Patients with isolated, mild GSP should undergo same-admission cholecystectomy; early cholecystectomy within 48 hours of admission has been supported by several randomized clinical trials. Cholecystectomy should be delayed for patients with severe disease; for severe and moderately severe disease, the optimal timing remains unclear. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is only useful for patients with suspected cholangitis or biliary obstruction, although the concomitance of these conditions in patients with GSP is rare. Modality of evaluation of the common bile duct to rule out concomitant choledocholithiasis varies and should be tailored to level of concern based on objective measures, such as laboratory results and imaging findings. Among these modalities, intraoperative cholangiography is associated with reduced length of stay and decreased use of ERCP. However, the benefit of routine intraoperative cholangiography remains in question.Conclusions and RelevanceTreatment of GSP is dependent on disease severity, which can be difficult to assess. A comprehensive review of clinically relevant evidence and recommendations on GSP severity grading, fluid resuscitation, timing of cholecystectomy, need for ERCP, and evaluation and management of persistent choledocholithiasis can help guide clinicians in diagnosis and management.

show abstract

Section: Discussion and Observationsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Gallstone Pancreatitis

McDermott,

Kao,

Keeley

et al. 2024

JAMA Surg

View full text Add to dashboard Cite

show abstract

“…Conflicting recommendations suggest that sphincterotomy should not be performed in the absence of choledocholithiasis or cholangitis due to the increased risk of the procedure 27 , 28 . Other studies recommend sphincterotomy as definitive treatment in patients who are deemed unfit for cholecystectomy 29 and as an indication for gallbladder drainage 30 .…”

Section: Discussionmentioning

confidence: 99%

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Kosti¹,

Borakati²,

Varma³

et al. 2023

BJS Open

View full text Add to dashboard Cite

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.

show abstract

“…(Figure 1B) The patient took an uncomplicated further clinical course on the normal ward. Same‐admission cholecystectomy was recommended, however, declined by the patient 2 . This case is uncommon in illustrating stone material above, at, and below the level of the papilla reflecting the dynamics in stone migration in acute biliary pancreatitis.…”

Section: Figurementioning

confidence: 95%