Abstract
BackgroundIdiopathic acute pancreatitis is diagnosed in approximately 10–30 % of cases of acute pancreatitis. While there is evidence to suggest that the cause in many of these patients is microlithiasis, this fact has not been translated into a resource efficient treatment strategy that is proven to reduce recurrence rates. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound. MethodsThis was a retrospective study of 2236 patients who presented to a regional Australian hospital. Patients were included when diagnosed with acute pancreatitis with no confirmed cause. Recurrence of acute pancreatitis was compared between those that did and did not undergo cholecystectomy. ResultsOne hundred ninety-five consecutive patients met the study definition of “idiopathic” acute pancreatitis. 33.8 % (66/195) underwent cholecystectomy. The patients who had cholecystectomy had a recurrence rate of 19.7 % (13/66) whereas, of those managed expectantly, 42.8 % (68/159) had at least one recurrence of acute pancreatitis (P = 0.001). ConclusionsFollowing an episode of acute pancreatitis with no identifiable cause, in patients fit for surgery, cholecystectomy should be considered to reduce the risk of recurrent episodes of pancreatitis.
Highlights
Gallstones and alcohol are by far the most common causes of cases of acute pancreatitis
For all 195 patients, there was another documented medical encounter within the region that confirmed they had not left the region. This was a retrospective study of 2236 patients that presented to the University Hospital Geelong, Australia with acute pancreatitis from January 2005 through to January 2015
Idiopathic acute pancreatitis was diagnosed where a causative factor could not be determined through history, physical examination, laboratory studies and non-invasive imaging such as trans-abdominal ultrasound or computerised tomography
Summary
Gallstones and alcohol are by far the most common causes of cases of acute pancreatitis. A definite cause is unable to be determined in 10–30 % of patients so that a diagnosis of idiopathic acute pancreatitis is assumed.[1] The 2013 guidelines published by the American College of Gastroenterology and the. IAP/APAWorking Group 2, 3 suggest that patients with idiopathic acute pancreatitis warrant further assessment by endoscopic ultrasound or magnetic resonance cholangiopancreatography to identify microlithiasis, neoplasms or chronic pancreatitis. These recommendations are weak, based on low quality evidence, and access to such investigations is often limited within the public health system. The aim of this study was to examine the value of prophylactic cholecystectomy following an episode of acute pancreatitis in patients with no history of alcohol abuse and no stones found on ultrasound
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