November 12, 2014
Journal: JRSM Short Rep
Short Title: Prevalence of cholecystitis in gallbladder histology following clinical pancreatitis: cohort study
Alternate Journal: JRSM short reports
ISSN: 2042-5333 (Electronic)
Accession Number: 24040504
Notes: Hung, Amy
JRSM Short Rep. 2013 Jul 30;4(9):2042533313490294. doi: 10.1177/2042533313490294. eCollection 2013.
Author Address: University Hospital of Lewisham, London, SE13 5DW, UK.
Reference Type: Journal Article
Record Number: 5080Author: Hwang, S. S., Li, B. H. and Haigh, P. I.
Title: Gallstone pancreatitis without cholecystectomy
Journal: JAMA Surg
Short Title: Gallstone pancreatitis without cholecystectomy
Alternate Journal: JAMA surgery
ISSN: 2168-6262 (Electronic)
Accession Number: 23884515
Keywords: Acute Disease
*Cholangiopancreatography, Endoscopic Retrograde
Abstract: IMPORTANCE: Current guidelines recommend that patients with an initial episode of gallstone pancreatitis receive cholecystectomy. However, for various reasons, many patients do not. OBJECTIVE: To determine the risk of developing recurrent gallstone pancreatitis in patients who never receive a cholecystectomy. DESIGN: Retrospective cohort study using electronic medical records. SETTING: Inpatient and outpatient. PATIENTS: All patients in Kaiser Permanente Southern California with a primary diagnosis of acute gallstone pancreatitis hospitalized from January 1, 1995, through December 31, 2010, with no previous diagnosis of gallstone pancreatitis documented in the medical record. INTERVENTIONS: Endoscopic retrograde cholangiopancreatography (ERCP) with or without sphincterotomy and/or stent placement, or no intervention. MAIN OUTCOMES AND MEASURES: Recurrent acute pancreatitis. RESULTS: A total of 1119 patients were identified. The median age at diagnosis was 63 years. Among the patients, 802 received no intervention and 317 received ERCP. After a median follow-up of 2.3 years, the overall risk of recurrent pancreatitis was 14.6%; it was 8.2% and 17.1% in patients who had ERCP and no intervention, respectively (P < .001). The median time to recurrence was 11.3 and 10.1 months in the patients who had ERCP and no intervention, respectively. Kaplan-Meier estimates of recurrence for 1, 2, and 5 years in the ERCP group were 5.2%, 7.4%, and 11.1%, compared with 11.3%, 16.1%, and 22.7% in the no-intervention group (hazard ratio = 0.45; 95% CI, 0.30-0.69; P < .001). Charlson Comorbidity Index and intensive care unit stay were independently associated with recurrence, whereas age, sex, and admission Ranson score were not associated. CONCLUSIONS AND RELEVANCE: In patients who did not undergo cholecystectomy, the risk of recurrent pancreatitis is significant. Endoscopic retrograde cholangiopancreatography mitigates this risk and should be considered during initial hospitalization if cholecystectomy is not done.