Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in <i>Situ</i> Gallbladder and Alithiasic Bile Duct: Is It Justified?

Abstract

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 101 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.