ABSTRACT
Background: An early decompression of the biliary tract can be useful in biliary pancreatitis. This can be accomplished with an ERCP. Aim: To analyze prospectively the outcomes of ERCP and eventual endoscopic management among patients with mild acute biliary pancreatitis with gallbladder in situ. Material and methods: We studied 90 consecutive patients aged between 15 and 92 years (71 females) with mild acute pancreatitis and gallbladder in situ, that were subjected to an ERCP and eventual sphincterotomy. Forty nine patients (54 percent) had jaundice and 12 (13 percent) had cholangitis. Results: In 67 patients (74 percent), ERCP detected an abnormal ampulla. The bile duct was successfully cannulated in 89 cases (99 percent). Of these, 42 (47 percent) had a dilated bile duct and 36 (40 percent) had choledocholithiasis. In two patients (2 percent) ERCP was only diagnostic. In the remaining patients, it was therapeutic. Endoscopic treatment was successful in 86 patients (99 percent). No complications arising from the endoscopic procedure were recorded. Follow-up was completed in 84 patients (94 percent). Of these, 10 (12 percent) were not subjected to a cholecystectomy, in eight due to a high surgical risk and in two due to refusal. In the remaining 74 patients, a cholecystectomy was performed during the same hospitalization in 57 (77 percent) and on a deferred basis in 17 (23 percent). Conclusions: In patients with mild acute biliary pancreatitis and gallbladder in situ, ERCP is a safe and effective method.
Objetivo: Analizar en forma prospectiva los resultados de la Colangio Pancreatografía Retrógrada Endoscópica (CPRE) y eventual manejo endoscópico en pacientes portadores de pancreatitis aguda biliar (PAB) leve con vesícula in situ. Material y Método: Se estudiaron 90 pacientes consecutivos con PAB leve y vesícula in situ. La edad promedio fue de 49,5 +/- 18,6 años (78,9 por ciento mujeres y 21,1 por ciento hombres). Del total, 49 pacientes (54,4 por ciento) presentaron ictericia y 12 (13,3 por ciento) colangitis. Resultados: La CPRE pesquisó pato-logia de la ampolla en 67/90 pacientes (74,4 por ciento). La canulación selectiva de la vía biliar resultó exitosa en 89/90 casos (98,9 por ciento). En estos, se demostró una vía biliar dilatada en 42 (47,2 por ciento) y coledocolitiasis en 36 (40,4 por ciento). La CPRE fue diagnóstica en 2 enfermos (2,2 por ciento) y hubo indicación de procedimiento terapéutico en los 87 restantes (97,7 por ciento), este resultó exitoso en 86 (98,9 por ciento). No se presentaron complicaciones derivadas de la cirugía endoscópica. Se completó el seguimiento en 84/89 pacientes (94,4 por ciento). De estos, 10 (11,9 por ciento) no fueron colecistectomizados (8 debido al riesgo quirúrgico y 2 por rechazo a la intervención). De los 74 restantes, 57 (77 por ciento) fueron sometidos a una colecistectomía dentro de la misma hospitalización y 17 (23 por ciento en forma diferida. El 91,9 por ciento de ellas (68/74) mediante laparoscopia. Conclusión: En pacientes con PAB leve y vesícula in situ, la CPRE es un método seguro y efectivo. Además, permite efectuar una colecistectomía por vía laparoscópica, durante la misma hospitalización en la gran mayoría de los pacientes y constituye una alternativa a la colecistectomía en pacientes de alto riesgo quirúrgico.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Common Bile Duct/surgery , Common Bile Duct/pathology , Gallbladder , Pancreatitis/surgery , Pancreatitis/diagnosis , Cholangiopancreatography, Endoscopic Retrograde/methods , Acute Disease , Follow-Up Studies , Prospective StudiesABSTRACT
BACKGROUND: The requirement for subsequent cholecystectomy in patients with gallbladder in situ after endoscopic removal of stones from the common bile duct (CBD) is controversial. The aims of this study were to assess the requirement for subsequent cholecystectomy for gallbladder-related symptoms, and to identify the patients who develop symptoms after the endoscopic removal of CBD stones. METHODS: Of 241 patients with gallbladder in situ following endoscopic removal of stones from the CBD, 146 patients (78 men and 68 women; mean age 69+/-13 years, range 20-93) with a follow-up time of more than three months without elective cholecystectomy were enrolled in the study. Fifty-nine patients had gallbladder stones (single stones in 27 and multiple stones in 32) and 87 patients had gallbladder in situ without stones. The time from entry to the occurrences of death or cholecystectomy was evaluated retrospectively. Cox regression analysis was used to evaluate the risk factors associated with these events. RESULTS: The mean duration of follow-up was 24.1+/-18.0 months (range 3-70 months). During follow-up, seven patients (4.8%) underwent cholecystectomy, on average 18.4 months after CBD stone removal, as the result of acute cholecystitis in four cases, biliary pain in two cases and acute pancreatitis in one case. Laparoscopic cholecystectomy was performed in four patients and open cholecystectomy in three patients. Post-operative morbidity occurred in two patients, with improvement after conservative management. Nine patients (6.2%) died as the result of unrelated biliary disease. Age, sex, presence of gallbladder stones, multiplicity of gallbladder stones and underlying disease did not correlate with subsequent cholecystectomy by Cox regression analysis. CONCLUSION: Elective cholecystectomy is not warranted in patients with bile duct stones when the common duct can be cleared of stones by endoscopic sphincterotomy. We could not find any clinical predictors of further symptoms or complications arising from the retained gallbladder.