Recurrence of idiopathic acute pancreatitis after cholecystectomy: systematic review and meta-analysis

Abstract

Background Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP. Methods PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta-analyses were undertaken to calculate risk ratios using a random-effects model with the inverse-variance method. Results Overall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07). Conclusion Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause.

The influence of cholecystectomy and recurrent biliary events on the risk of post-pancreatitis diabetes mellitus: a nationwide cohort study in patients with first attack of acute pancreatitis

“…This approach was chosen because gallstones are often thought to be an underlying cause of idiopathic AP and the current ICD codes are not sufficiently accurate in identifying etiology. 2,31 Fourth, data on blood glucose metabolism were not available and PPDM was identified based on healthcare utilization data. Although the pharmaceutical dispensing data used in the identification of PPDM were from all levels of healthcare providers (including primary care), one could argue that there is still a possibility of misclassification of PPDM.…”

“…Gallstones are the predominant etiology of acute pancreatitis (AP) in the Western world, observed in up to 54% of AP cases. 1 Further, gallstones are often thought to be an underlying cause of idiopathic AP, 2 which accounts for 15-22% of AP cases. 3 After first attack of AP, 22% of AP patients develop recurrent attacks.…”

“…4 Previous studies have demonstrated that cholecystectomy reduces the risk of recurrent AP. 2,5 Hence, guidelines recommend that patients with mild AP undergo a cholecystectomy (if eligible for the surgery and thought to benefit from the surgery) either during the same hospital admission 6 or after a waiting period of no more than 4-6 weeks. 7 Growing evidence also indicates that, besides recurrent attacks, patients with AP (including its mild form) often develop metabolic sequelae after clinical resolution, such as post-pancreatitis diabetes mellitus (PPDM).…”

Acute Pancreatitis: Diagnosis and Treatment

“…ERCP and sphincterotomy alone can halve the risk of recurrent pancreatitis in those unfit for surgery, but does not reduce the risk to the same extent as cholecystectomy [141], and increases the risk of subsequent cholecystitis from compromise of sphincter of Oddi function. If extensive investigation for aetiology is negative, resulting in an idiopathic diagnosis, cholecystectomy may still be justified; recurrence after cholecystectomy in idiopathic acute pancreatitis is lower than with conservative management [218].…”

Central role of the sentinel acute pancreatitis event (SAPE) model in understanding recurrent acute pancreatitis (RAP): Implications for precision medicine

“…The risk of RAP is very high in these patients, and cholecystectomy (CCY) is recommended as soon as possible, even during the sentinel AP admission. Comparing patients with and without CCY suggest (a) the rate of RAP is ~30%, that (b) is reduce to ~11% with CCY ( 30 ). However, the rate of AP in controls (e.g., the general population) with gallbladders in situ was not calculated (i.e., the risk of AP is only at a very high level after the sentinel acute pancreatitis event).…”