Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis

Abstract

Background: Gallstones account for 30-50 per cent of all presentations of acute pancreatitis. While the management of acute pancreatitis is usually supportive, definitive treatment of gallstone pancreatitis is cholecystectomy. Guidelines from the British Society of Gastroenterology suggest definitive treatment on index admission or within 2 weeks of discharge, whereas joint recommendations from the International Association of Pancreatology and the American Pancreatic Association recommend definitive treatment on index admission. Evidence suggests that uptake of these guidelines is low.Methods: Embase, MEDLINE and Cochrane databases were searched for RCTs investigating early versus delayed cholecystectomy in patients with a confirmed diagnosis of mild gallstone pancreatitis. The pooled synthesis was undertaken using a random-effects meta-analysis of the primary outcome of recurrent biliary complications causing hospital readmission. Secondary outcomes included intraoperative and postoperative complications, and total length of hospital stay (LOS). All analyses were performed using RevMan5 software. Results: Five RCTs were identified, which included 629 patients (318 in the early cholecystectomy (EC) group and 311 in the delayed cholecystectomy (DC) group). Recurrent biliary events that required readmission were reduced in patients undergoing EC compared with the number in patients having DC(odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅09 to 0⋅33). There was no difference in the rate of intraoperative (OR 0⋅58, 0⋅17 to 1⋅92) or postoperative (OR 0⋅78, 0⋅38 to 1⋅62) complications.Conclusion: EC following mild gallstone pancreatitis does not increase the risk of intraoperative or postoperative complications, but reduces the readmission rate for recurrent biliary complications.

Consensus and controversy among severe pancreatitis surgery guidelines: a guideline evaluation based on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool

“…We retrieved the latest evidence for a metaanalysis of a randomized controlled study. It was found that for mild biliary pancreatitis, previous studies have confirmed that cholecystectomy at the same time of hospitalization can reduce the recurrence rate of pancreatitis (23).…”

Effect of transient obstructive cholestasis on liver histology: a cross-sectional study

“…[13][14][15] Similarly, Moody et al, in a meta-analysis study, observed that early cholecystectomy reduced the frequency of readmissions due to biliary complications, among individuals with previous episodes of acute biliary pancreatitis. 16 The duration of obstruction was significantly associated with the severity of both cholestasis and ductular proliferation. This highlights the progressive aspect of these changes in relation to the duration of the causative condition and, of course, emphasizes the importance of early treatment in order to avoid the development of chronic disease.…”

Indications for endoscopic retrograde cholangiopancreatography and cholecystectomy in biliary pancreatitis

“…Based on this trial, cholecystectomy is recommended during the index admission in patients with mild ABP. Failure to remove the gallbladder on index admission resulted in an increase in gallstone‐related complications such as pancreatitis, biliary colic and readmissions, as confirmed in a meta‐analysis. With respect to conversion rates from laparoscopy to laparotomy or surgical complexity, no differences between groups were detected.…”