Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources

Abstract

Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method:We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse.Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis), with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified.Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in <i>Situ</i> Gallbladder and Alithiasic Bile Duct: Is It Justified?

“…Our study is the first prospective randomized report one in the literature with long-term follow-up. This confirms, what was found by other non-randomized studies with short follow-up [53] [54] [55] [56] [59], that risk of recurrence is significant in patients with mild acute biliary pancreatitis, without bile duct stones, and in whom cholecystectomy is not performed; thus, an ES is recommended.…”

Symptomatic gallstone disease: Recurrence patterns and risk factors for relapse after first admission, the RELAPSTONE study

“…Regarding age, the actual evidence is controversial. Some studies showed no increased risk with age in patients with AP 25,26 . However, these studies were single‐center, retrospective, with few patients, and in the case of Zhang et al 26 .…”

“…Some studies showed no increased risk with age in patients with AP. 25 , 26 However, these studies were single‐center, retrospective, with few patients, and in the case of Zhang et al. 26 took into account different etiologies of AP.…”

“…Higher blood levels of ALT and lower blood leukocyte count during admission were associated with a greater risk of relapses; ALT>35U/L (HR = 1.22; 95% CI: relapses. 25,26,30 Elevated ALT might be linked to gallstone passage through bile ducts, as observed in AP, where ALT >150U/L suggests gallstone etiology. 31 As for leukocytosis, there is no previous evidence.…”

“…Some studies showed no increased risk with age in patients with AP. 25,26 However, these studies were single-center, retrospective, with few patients, and in the case of Zhang et al 26 18 observed that younger patients had a higher risk of recurrent AP, and de Mestral et al 12 showed similar results in patients with ACC discharged without cholecystectomy.…”