Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in <i>Situ</i> Gallbladder and Alithiasic Bile Duct: Is It Justified? — Oak Academic Publishing
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Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in <i>Situ</i> Gallbladder and Alithiasic Bile Duct: Is It Justified?
General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
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General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
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General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
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Public Health Department, School of Medicine, University of Concepción, Concepcion, Chile
1 General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
2 General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
3 General and Digestive Surgery Department, School of Medicine, University of Concepción, Concepcion, Chile
4 Public Health Department, School of Medicine, University of Concepción, Concepcion, Chile
Objective : To compare the long-term results of the treatment of mild acute biliary pancreatitis in patients with gallbladder in situ , without stones in the bile duct, treated by cholecystectomy, and endoscopic sphincterotomy (ES) versus simple cholecystectomy in the prevention of recurrence of this pathology. Material and Methods : Between May 2008 and December 2012, 110 consecutive patients with a mild acute biliary pancreatitis (ABP) were prospectively studied. None had undergone cholecystectomy, and choledocholithiasis was ruled out by ERCP. Two groups of patients were created and randomized: Group I (n = 55) who underwent ERCP plus ES and Group II (n = 55) only had diagnostic ERCP. Patients were then referred for cholecystectomy. Follow up was completed in 1 01 patients. Group I was made up of 53 patients and Group II had 48 similar characteristics. Patients were followed for an average of 105 months. At the end of the follow-up, 12 (22.6%) from Group I and 6 (12.5%) from Group II (p = 0.143) remained with the gallbladder in situ . Results : There were 53 patients in Group I (100%). Only 42 (87.5%) of those in Group II evolved without biliopancreatic complications (p = 0.0096). In the latter, 6 (12.5%) were complicated, and 5 had not had cholecystectomy. In Group I patients, there was no recurrence of acute biliary pancreatitis, but this was seen in 4 cases (8.4%) in Group II (p = 0.0476). Group I also had 2 cases of biliary colic (4.2%) and 2 cases of obstructive jaundice (4.2%). Conclusions : The 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.
KeywordsPancreatitisEndoscopic Sphincterotomy
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