Year 2016 / Volume 108 / Number 3
Original
Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources

117-122

DOI: 10.17235/reed.2016.4086/2015

Natalia Bejarano González, Andreu Romaguera Monzonís, Francisco Javier García Borobia, Neus García Monforte, Sheila Serra Plà, Pere Rebasa Cladera, Roser Flores Clotet, Salvador Navarro Soto,

Abstract
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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References
1. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis. A systematic review. Pancreas 2006; 33: 323-30.
2. Boadas J, Balsells J, Busquets J et al. Valoración y tratamiento de la pancreatitis aguda. Documento de posicionamiento de la Societat Catalana de Digestologia y Societat Catalana de Pàncrees. Gastroenterol Hepatol 2015; 38: 82-96.
3. Sekimoto M, Takada T, Kawarada Y et al. JPN guidelines for the management of acute pancreatitis. Epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg 2006; 13: 10-24.
4. Gullo L, Migliori M, Pezzilli R et al. An update on recurrent acute pancreatitis: data from five european countries. Am J Gastroenterol 2002; 97: 1959-62.
5. Somogyi L, Martin SP, Venkatesan T et al. Recurrent acute pancreatitis: an algorithmic approach to identification and elimination of inciting factors. Gastroenterology 2001; 120: 708-17.
6. Kimura Y, Takada T, Kawadara Y et al. JPN guidelines for the management of acute pancreatitis: treatment of gallstone-induced acute pancreatitis. J Hepatobiliary Pancreat Surg 2006; 13: 56-60.
7. DiehlAK, Holleman DR, Chapman JB et al. Gallstone size and risk of pancreatitis. Arch Intern Med 1997; 157: 1674-8.
8. Monkhouse SJW, Court EL, Dash I et al. Two-week target for laparoscopic cholecystectomy following gallstone pancreatitis is achievable and cost neutral. Br J Surg 2009; 96: 751-5.
9. Zhang W, Shan HC, Gu Y. Recurrent acute pancreatitis and its relative factors. World J Gastroenterol 2005; 11: 3002-4.
10. NebikerCA, Frey DM, Hamel CT et al. Early versus delayed cholecystectomy in patients with biliary acute pancreatitis. Surgery 2009; 145: 260-4.
11. Frei GJ, Frei VT, Thirlby RC et al. Biliary pancreatitis: clinical presentation and surgical management. Am J Surg 1986; 151: 170-5.
12. Whitlock TL, Repas K, Tignor A et al. Early readmission in acute pancreatitis: incidence and risk factors. Am J Gastroenterol 2010; 105: 2492-7.
13. Hernández V, Pascual I, Almela Pet al. Recurrence of acute gallstone pancreatitis and relationship with cholecystectomy or endoscopic sphincterotomy. Am J Gastroenterol 2004; 99: 2417-23.
14. WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects (en línea) http://www.wma.net/en/30publications/10policies/b3/index.html(query: March 20, 2010).
15. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol 2006; 101: 2379-400.
16. Ranson JH, Rifkind KM, Roses DF et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 1974; 139: 69-81.
17. Balthazar EJ, Feeny PC, Van Sonnenberg E. Imaging and intervention in acute pancreatitis. Radiology 1994; 193: 297-306.
18. Ley orgánica 15/1999 del 13 de diciembre de protección de datos de carácter personal (LOPD). (BOE nº 298 del 14/12/1999).
19. Navarro S, Amador J, Argüello L et al. Recomendaciones del Club Español Biliopancreático para el tratamiento de la PA. Conferencia de consenso. Gastroeneterol Hepatol 2008; 31: 366-87.
20. UK Working Party on acute pancreatitis. UK guidelines for the management of acute pancreatitis. Gut 2005; 54(Suppl III): iii1-iii9.
21. AGA Institute Medical Position Statement on acute pancreatitis. Gastroenterology 2007; 132: 2019-21.
22. Uhl M, Warshaw A, Imrie C et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002; 2: 565-73.
23. McCullough LK, Sutherland FR, Preshaw R et al. Gallstone pancreatitis: does discharge and readmission for cholecystectomy affect outcome? HBP 2003; 5: 96-9.
24. Frei GJ, Frei VT, Thirlby RC et al. Biliary pancreatitis: clinical presentation and surgical management. Am J Surg 1986; 151: 170-5.
25. Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis; a systematic review. Pancreas 2006; 33: 323-30.
26. Gullo L, Migliori M, Pezzilli R et al. An update on recurrent acute pancreatitis: data from five european countries. Am J Gastrolenterol 2002; 97: 1959-62.
27. Banks PA, Bollen TL, Dervenis C et al. Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: Revision of the Atlanta classification and definitions by international consensus Acute Pancreatitis Classification Working Group. Gut 2013; 62: 102-11.
28. Cameron DR, Goodman AJ. Delayed cholecystectomy for gallstone pancreatitis: readmissions and outcome. Ann R Coll Surg Engl 2004; 86: 358-62.
29. Lankinsch PG, Weber-Dany B, Lerch MM. Clinical perspectives in pancreatology: compliance with acute pancreatitis guidelines in Germany. Pancreatology 2005; 5:591-3.
30. Lankisch PG,Breuer N, Bruns A et al. Natural history of acute pancreatitis: a long term population based study. Am J Gastroenterol 2009; 104: 2797-805.
31. Modifi R, Madhavan KK, Garden OJ et al. An audit of the management of patients with acute pancreatitis against national standards of practice. Br J Surg 2007; 94: 844-8.
32. Bakker OJ, Van Santvoort HC, Hagenaars JC et al. for the Dutch Pancreatitis Study Group. Timing of cholecystectomy after mild biliary pancreatitis. Br J Surg 2011; 98: 1446-54.
33. Da Costa DW, Bouwense SA, Schepers NJ et al. Same-admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet 2015; 386: 1261-8.
34. Moreau JA, Zinsmeister AR, Melton III LJ et al. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study. Mayo Clin Proc 1988; 63: 466-73.
35. Gloor B, Stahel PF, Müller CA et al. Incidence and management of biliary pancreatitis in cholecystectomized patients: results of a 7 year study. J Gastrointest Surg 2003; 7: 372-7.
36. Trna J, Vege SS, Pribramska V et al. Lack of significant liver enzyme elevation and gallstones and/or slugde on ultrasound on day 1 of acute pancreatitis is associated with recurrence after cholecystectomy: a population-based study. Surgery 2012; 151: 199-205.
37. Ito K, Ito H, Whang EE. Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines? J Gastrointes Surg 2008; 12: 2164-70.
38. Del Pozo D, Tabernero S, Poves E et al. Usefullness of endoscopic ultrasonography in the clinical suspicion of biliary disease. Rev Esp Enferm Dig 2011; 103: 345-8.
39. Pérez-Cuadrado E. El papel de la ecoendoscopia en la vía biliar. La gran amiga de la ERCP. Rev Esp Enferm Dig 2011; 103: 341-4.
40. Lee JK, Ryu JK, Park JK et al. Roles of endoscopic sphincterotomy and cholecystectomy in acute biliary pancreatitis. Hepatogastroenterology 2008; 55: 1981-5.
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Bejarano González N, Romaguera Monzonís A, García Borobia F, García Monforte N, Serra Plà S, Rebasa Cladera P, et all. Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence. Consequences of lack of resources. 4086/2015


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Publication history

Received: 06/11/2015

Accepted: 19/12/2015

Online First: 11/02/2016

Published: 26/02/2016

Article revision time: 38 days

Article Online First time: 97 days

Article editing time: 112 days


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