Lack of significant liver enzyme elevation and gallstones and/or sludge on ultrasound on day 1 of acute pancreatitis is associated with recurrence after cholecystectomy: A population-based study

Trna, Jan; Vege, Santhi Swaroop; Příbramská, Veronika; Chari, Suresh T.; Kamath, Patrick S.; Kendrick, Michael L.; Farnell, Michael B.

doi:10.1016/j.surg.2011.07.017

Cited by 32 publications

(20 citation statements)

References 35 publications

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“…The minor papilla is cannulated while the duodenoscope is in the long position. Opacification of the dorsal pancreatic duct across the spine confirms the diagnosis of complete pancreas divisum in this patient with RAP and previously unremarkable CT scan and EUS transabdominal US [27]. The likelihood of recurrent pancreatitis after cholecystectomy was significantly higher (61 %) when neither was present compared to patients with both these abnormalities (9 %).…”

Section: What Is the Role Of Empiric Biliary Sphincterotomy?supporting

confidence: 71%

“…In patients with an intact gallbladder, the prevalence of occult biliary sludge (suspension of crystals and other material in bile) or microlithiasis (small stones < 3 mm in diameter) may be as high as 75 % [26,27]. The probability of microlithiasis as a cause for pancreatitis is increased when microcrystals are identified from bile or duodenal aspirate; although these studies were primarily completed in an era when MRCP and EUS were in their nascence [20,28,29].…”

Section: Diagnosis and Initial Evaluationmentioning

confidence: 99%

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Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

Bang

Coté

2015

ERCP and EUS

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A 44-year-old female presents to the office 1 month following an episode of acute pancreatitis (AP). She denies a history of alcohol use and smoking, has no family history of pancreatitis, and takes no medications. At the time of her presentation, serum liver chemistries, calcium, and triglyceride levels were normal; serum lipase was more than three times the upper limit of normal. At the time of admission, a transabdominal ultrasound (US) showed changes of prior cholecystectomy; this had been performed for intermittent abdominal pain and suspected chronic cholecystitis 5 years ago. The common bile duct was poorly visualized but felt to be normal in diameter. During her admission, a contrast-enhanced abdominal computed tomography (CT) revealed peripancreatic stranding consistent with interstitial AP. There was no evidence of chronic pancreatitis or other structural abnormalities.She has fully recovered from this recent episode of AP, but now reports intermittent episodes of transient, mild epigastric pain, each lasting 15-60 min. She is asymptomatic in the office, but concerned for her risk of permanent damage to her pancreas, and fears recurrence of the severe abdominal pain that prompted admission with AP. She is diagnosed with idiopathic AP. What is your diagnostic and therapeutic approach?

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Section: What Is the Role Of Empiric Biliary Sphincterotomy?supporting

confidence: 71%

Section: Diagnosis and Initial Evaluationmentioning

confidence: 99%

Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

Bang

Coté

2015

ERCP and EUS

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“…Other authors describe recurrence rates of 13% (35) to 17% (36). Such relapses have been attributed to residual choledochal lithiasis (35).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…In such cases clinical or instrumental evidence of bile duct obstruction is observed and the question of who will develop a post-cholecystectomy AP remains open. Even serum elevations of hepatocellular enzymes during the AP episode show no correlation with the possibility of a subsequent (post-surgical) AP episode [4]. On this gouns is based our proposal to apply the rendezvous approach in all cases in which the diagnosis of ABP is certain, even if no signs of bile duct obstruction are present.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate timing of video laparoscopic cholecystectomy (VLC) is estimated to minimize the risk of recurrent pancreatitis [3] during the waiting time for operation. Nevertheless, the incidence of Recurrent Acute Pancreatitis after cholecystectomy still reaches high incidences (up to 17%) [4]. As recently demonstrated, it is very hard to differentiate during the hospitalization for a pancreatitis attack between patients destined to be cured by the simple cholecystectomy and patients bound to recur after the cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

Can We Prevent the Post-Cholecystectomy Recurrent Pancreatitis?

Basile¹,

Mazzarulli²,

G³

et al. 2014

Pancreat Disord Ther

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Laparoscopic Cholecystectomy is an essential part of treatment of so called pancreatitis. It seems a necessary but not sufficient therapeutical act as demonstrated by the biliary still high incidence of post-cholecystectomy pancreatitis. There is no means of knowing which patient affected by biliary pancreatitis with no diagnosable abnormalities of the biliary main tract will develop a recurrent pancreatitis. This study supports the concept that by adding a "clearance" of the biliary tact at the cholecystectomy (so called rendezvous technique), a prevention of recurrent pancreatitis can be obtained. This observational study includes 39 hospitalized patients suffering from an acute biliary pancreatitis episode. None of them had serum bilirubin elevation or jaundice, and 27 had no instrumental evidence of bile duct obstruction while 12 had minor stones in the main bile duct. Rendezvous technique revealed undiagnosed bile duct abnormalities either functional or organic in 13 cases. During a 5 years follow-up period after the procedure no recurrent pancreatitis were observed. Our experience has shown that the technique of Rendezvous can reveal and treat obstructions of the bile duct that have not been diagnosed with instrumental examinations; furthermore, this technique seems to prevent the development of recurrent acute pancreatitis.

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Lack of significant liver enzyme elevation and gallstones and/or sludge on ultrasound on day 1 of acute pancreatitis is associated with recurrence after cholecystectomy: A population-based study

Cited by 32 publications

References 35 publications

Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

Idiopathic Acute Pancreatitis and Sphincter of Oddi Dysfunction: Diagnostic and Therapeutic Role of ERCP and Sphincter of Oddi Manometry

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

Can We Prevent the Post-Cholecystectomy Recurrent Pancreatitis?

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