TITLE:
Endoscopic Sphinterotomy in Patients with Mild Acute Biliary Pancreatitis, in Situ Gallbladder and Alithiasic Bile Duct: Is It Justified?
AUTHORS:
Mario Anselmi Méndez, Ana María Gemmato Pascazi, Julio Salgado Oyarzún, Maritza Flores Opazo
KEYWORDS:
Pancreatitis, Endoscopic Sphincterotomy
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.11 No.7,
July
26,
2021
ABSTRACT: Objective: To compare the long-term results of the treatment of mild acute biliary
pancreatitis in patients with gallbladder in situ, without stones in the bile
duct, treated by cholecystectomy, and endoscopic sphincterotomy (ES) versus
simple cholecystectomy in the prevention of recurrence of this pathology. Material and Methods:
Between May 2008 and December 2012, 110 consecutive patients with a mild acute
biliary pancreatitis (ABP) were prospectively studied. None had undergone
cholecystectomy, and choledocholithiasis was ruled out by ERCP. Two groups of
patients were created and randomized: Group I (n = 55) who underwent ERCP plus
ES and Group II (n = 55) only had diagnostic ERCP. Patients were then referred
for cholecystectomy. Follow up was completed in 101 patients. Group I was made up of 53 patients and
Group II had 48 similar characteristics. Patients were followed for an average
of 105 months. At the end of the follow-up, 12 (22.6%) from Group I and 6
(12.5%) from Group II (p = 0.143) remained with the gallbladder in situ. Results: There were 53 patients
in Group I (100%). Only 42 (87.5%) of those in Group II evolved without
biliopancreatic complications (p = 0.0096). In the latter, 6 (12.5%) were
complicated, and 5 had not had cholecystectomy. In Group I patients, there was
no recurrence of acute biliary pancreatitis, but this was seen in 4 cases
(8.4%) in Group II (p = 0.0476). Group I also had 2 cases of biliary colic
(4.2%) and 2 cases of obstructive jaundice (4.2%). Conclusions : The risk of recurrence is significant in patients with mild acute
biliary pancreatitis, without bile duct stones, and in whom cholecystectomy is
not performed; thus, an ES is recommended.