61 Spontaneous Resolution of Biliary Obstruction in Patients With Acute Gallstone Pancreatitis and Acute Cholangitis: A Retrospective Study in a Single Medical Center

Abstract

INTRODUCTION: Spontaneous resolution of biliary obstruction has been reported in a high percentage of patients who present with gallstone acute pancreatitis (AP) and acute cholangitis (AC). Persistent biliary obstruction is associated with significant morbidity and requires urgent endoscopic intervention. Currently, the reported percentage of spontaneous resolution varies widely. Invasive intervention associated with its own risk and complication. Early identification of patients with spontaneous resolution of obstruction can help avoid unnecessary endoscopic intervention. METHODS: A retrospective chart review of patients admitted to University Hospital from June 2015 through Dec 2017 with a diagnosis of gallstone AP and AC. ICD-10 codes were used to identify the study cohort (K85.10, K85.11, K85.12, K85.90, K80.32, K80.33, K80.36, K80.37, K80.31). Inclusion criteria include patients with AP (exhibiting 2 out of 3 of abdominal pain, Lipase >3 times the upper limit of normal or features of pancreatitis on imaging with proof of obstruction on imaging) and AC (exhibiting fever, abdominal pain, and jaundice with proof of obstruction on imaging). Data were analyzed temporally using RM-ANOVA with each group as a between-subjects factor; all analyses were completed using SPSS (v. 25). RESULTS: Out of 398 patients reviewed, 114 patients were included. 35 patients (30%) demonstrated a stone on imaging and required intervention to relieve the obstruction. 17 (15%) patients showed stone on imaging and demonstrated the spontaneous passage of the stone via ERCP. 62 (54%) patients showed clinical suspicion of spontaneous passage on initial imaging with clinical improvement with or without intervention. No significant differences in characteristics, comorbidities or biochemical markers were identified. CONCLUSION: Data from this population-based cohort showed approximately 15% of stones demonstrated on imaging in AP and AC pass spontaneously without intervention. Unlike prior studies done in different populations, no significant difference was found in patients with demonstrated stone between those who required intervention and those who had a spontaneous passage that can help early recognition. A high percentage of patients (54%) showed clinical signs of spontaneous passage of the stone on admission.