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01.08.2008 | Ausgabe 8/2008

Surgical Endoscopy 8/2008

Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)

Zeitschrift:
Surgical Endoscopy > Ausgabe 8/2008
Autoren:
Pandanaboyana Sanjay, Sim Yeeting, Carole Whigham, Hannah Judson, Francesco M. Polignano, Iain S. Tait
Wichtige Hinweise
Presented as a poster at the Association of Surgeons of Great Britain and Ireland, Annual meeting, Manchester, 2007.
Published in abstract form P Sanjay, S Yeeting, C Whigham, H Judson, FM Polignano, IS Tait. Interval cholecystectomy is a reasonable alternative to index cholecystectomy in patients with severe gall stone pancreatitis. British Journal of Surgery; 2007; 94 (S2): 166

Abstract

Background

UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2  weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.

Methods

All patients that presented with GSP over a 4-year period (2002–2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.

Results

100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58%) had an index cholecystectomy, and 38 (42%) an interval cholecystectomy.
Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2–30) days for index cholecystectomy and 63 (13–210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5%) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.

Conclusions

This study demonstrates that overall 62% (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.

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