4678 Management of gallstone pancreatitis: cholecystectomy or ercp and endoscopic sphincterotomy.

Abstract

Background: Currently, laparoscopic (lap.) CCX is the recommended treatment of gallstone pancreatitis. ERCP and ES within 24-48 hours is suggested in the treatment of acute biliary pancreatitis. Aim: To assess role of lap. CCX after ERCP and ES in patients with gallstone pancreatitis. Methods: 118 patients with gallstone pancreatitis (mean age: 44, range: 18-68 yrs.), 102-F, 16-M were identified. Inclusion criteria were typical abdominal pain, serum amylase ≥ twice normal (normal ≤ 128), and gallbladder (GB) stones, dilated common bile duct (CBD) ±CBD stone by ultrasound (US), CT scan or ERCP. Results: 81 patients underwent CCX after initial evaluation including ERCP in 43 (53%) and ERCP + ES in 38 (47%). Of the 34 patients with no CCX, 33 underwent successful ERCP + ES only . Mean follow-up was 22 months (range 8-49). Recurrent pancreatitis was seen in 3 (3.7%) in CCX group (CBD stone in 2, papillary stenosis in 1), and in 2 (5.8%) in ERCP + ES only group (CBD stone and papillary restenosis in one, alcohol induced in other - this patient also had cholecystitis). 10 patients in ERCP + ES only group had follow-up US and showed persistent GB stones in 8 and disappearance of GB stones in 2. Procedure related complications included one patient with cystic duct leak in CCX group and one with mild ERCP induced pancreatitis in ERCP + ES only group. Conclusions: Recurrent pancreatitis after ERCP + ES only for gallstone pancreatitis is rare. In patients who have undergone ERCP + ES only for gallstone pancreatitis, CCX should be considered only in presence of symptomatic GB disease such as cholecystitis, cystic duct obstruction, etc. and not just to prevent recurrent gallstone pancreatitis.