Abstract

BackgroundOccult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP.MethodsPubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Studies published before 1980 or including chronic pancreatitis and case reports were excluded. The primary outcome was recurrence rate. Quality was assessed using the Newcastle–Ottawa Scale. Meta‐analyses were undertaken to calculate risk ratios using a random‐effects model with the inverse‐variance method.ResultsOverall, ten studies were included, of which nine were used in pooled analyses. The study population consisted of 524 patients with 126 cholecystectomies. Of these 524 patients, 154 (29·4 (95 per cent c.i. 25·5 to 33·3) per cent) had recurrent disease. The recurrence rate was significantly lower after cholecystectomy than after conservative management (14 of 126 (11·1 per cent) versus 140 of 398 (35·2 per cent); risk ratio 0·44, 95 per cent c.i. 0·27 to 0·71). Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38·9 per cent); risk ratio 0·41, 0·16 to 1·07).ConclusionCholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause.

Highlights

  • Acute pancreatitis is an increasing healthcare problem1 with a wide range of causes

  • Data were analysed based on the definitions of idiopathic acute pancreatitis (IAP) as outlined in the original articles, and according to current guidelines13, which define IAP as acute pancreatitis in which no aetiology can be determined by standard diagnostic evaluation, consisting of a detailed history, laboratory serum tests and imaging

  • This systematic review and meta-analysis showed that cholecystectomy might reduce the risk of recurrence of IAP

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Summary

Introduction

Acute pancreatitis is an increasing healthcare problem with a wide range of causes. A biliary cause is found in approximately half of patients, followed by alcohol consumption in approximately 20 per cent and less common causes such as medication, hypertriglyceridaemia and autoimmune diseases. Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Methods: PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis. Even in patients in whom IAP was diagnosed after more extensive diagnostic testing, including endoscopic ultrasonography or magnetic resonance cholangiopancreatography, the recurrence rate appeared to be lower after cholecystectomy (4 of 36 (11 per cent) versus 42 of 108 (38⋅9 per cent); risk ratio 0⋅41, 0⋅16 to 1⋅07). Conclusion: Cholecystectomy after an episode of IAP reduces the risk of recurrent pancreatitis. This implies that current diagnostics are insufficient to exclude a biliary cause

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