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Is empiric cholecystectomy a reasonable treatment option for idiopathic acute pancreatitis?

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 356–357 (2006)Cite this article

The cause of acute pancreatitis is easily identifiable in 70–90% of patients. In patients with idiopathic acute pancreatitis (IAP), however, an identifiable cause is not found after initial evaluation, which includes a full physical examination, evaluation of patient history, focused laboratory testing (calcium, triglycerides, and liver function), and routine radiologic testing (transabdominal ultrasound and CT). If initial evaluation does not reveal the cause, further specialized diagnostic evaluation is usually undertaken. Tests that can establish the etiology of an attack of acute pancreatitis include endoscopic ultrasound, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP), bile analysis (for the detection of microlithiasis), serologic testing (for the identification of autoimmune pancreatitis), and genetic testing (for genetic mutations encoding for cationic trypsinogen, pancreatic secretory trypsin inhibitor, and cystic fibrosis transmembrane conductance regulator). In some patients, however, even after extensive specialized evaluation, the etiology of the attack of acute pancreatitis remains elusive. We believe that empiric cholecystectomy is a reasonable treatment option in such patients.

Biliary pancreatitis is the most common cause of acute pancreatitis, and transabdominal ultrasound is the test most frequently used to detect biliary stones. Although ultrasound is very good at detecting gallbladder stones (with a sensitivity of >90%), its sensitivity for the detection of common bile duct stones is limited (20–75%). Furthermore, one probable cause of IAP in patients with a negative ultrasound is occult gallstone disease, which occurs in the form of biliary sludge or microlithiasis. It has been reported that ultrasound has a sensitivity of only 50% for the detection of biliary sludge.1,2 It should be emphasized that microlithiasis and biliary sludge are distinct entities: microlithiasis refers to stones <3 mm in diameter whereas biliary sludge is a viscous suspension of calcium and cholesterol crystals, mucin, glycoproteins, and proteinaceous material. The natural history of biliary sludge is variable. It has been shown to disappear in 50% of patients, persist in 20% of asymptomatic patients, and lead to the development of gallstones in 5–15% of patients.3

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Authors and Affiliations

  1. Assistant Professor of Medicine and Director of Endoscopy,

    William B Evans & Peter Draganov

  2. Fellow in Advanced Therapeutic Endoscopy at the University of Florida, Gainesville, FL, USA

    William B Evans & Peter Draganov

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  1. William B Evans
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  2. Peter Draganov
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Correspondence to Peter Draganov.

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Evans, W., Draganov, P. Is empiric cholecystectomy a reasonable treatment option for idiopathic acute pancreatitis?. Nat Rev Gastroenterol Hepatol 3, 356–357 (2006). https://doi.org/10.1038/ncpgasthep0527

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