Original Contribution
The American Journal of Gastroenterology (2004) 99, 2417–2423; doi:10.1111/j.1572-0241.2004.40896.x
Recurrence of Acute Gallstone Pancreatitis and Relationship with Cholecystectomy or Endoscopic Sphincterotomy
Vicent Hernandez MD1, Isabel Pascual MD, PhD1, Pedro Almela MD, PhD1, Ramon Añon MD, PhD1, Belen Herreros MD, PhD1, Vicente Sanchiz MD, PhD1, Miguel Minguez MD, PhD1 and Adolfo Benages MD, PhD1
1Department of Gastroenterology, University Clinic Hospital of Valencia, University of Valencia, Spain
Correspondence: Adolfo Benages, Department of Gastroenterology, University Clinic Hospital of Valencia, University of Valencia, Av. Blasco Ibañez, 17, 46010 Valencia, Spain
Received 1 August 2004; Revised 0000; Accepted 9 August 2004.
Abstract
OBJECTIVES:
To determine the prevalence of recurrence of gallstone pancreatitis, its clinical features, and the presence of prognostic factors of recurrence.
METHODS:
From January 1, 2000 to August 31, 2003, 233 patients admitted with acute gallstone pancreatitis (AGP) were prospectively studied. Patients were divided into two groups: recurrent and nonrecurrent group. Clinical, analytical, radiological, prognostic parameters, and severity (Atlanta criteria) were assessed, along with the performance of cholecystectomy or endoscopic sphincterotomy (ES). Clinical features of recurrence were analyzed. Univariate (
2, Student's t-test) and multivariate tests were performed. Statistical significance was assumed if p < 0.05.
RESULTS:
Two hundred and eighty-six attacks were identified. Forty-two patients (18.2%) recurred, suffering 53 recurrent attacks, which took place within 30 days in 23.3%. Patients who did not undergo surgery after the first attack had 31-fold risk of recurrence (OR = 31.5%, CI = 95%[7.22–137.84], p < 0.001). In patients not operated, recurrence was more frequent if ES was not performed (37.04%vs 0%, p= 0.019). Among patients with surgical risk, none who recurred underwent ES, compared with 27.9% of those who did not recur. Patients in the nonrecurrent group underwent cholecystectomy within the first 30 days or ES more frequently (31.2%vs 7.3%, p= 0.001).
CONCLUSIONS:
Recurrence of gallstone pancreatitis is a frequent event. Delay of cholecystectomy implies an increased risk of recurrence. ES could be an acceptable option to prevent recurrence in patients who are not candidates for surgery or who do not desire to undergo cholecystectomy.
