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Original Investigation | Pacific Coast Surgical Association

Gallstone Pancreatitis Without Cholecystectomy

Stephanie S. Hwang, MD1; Bonnie H. Li, MS2; Philip I. Haigh, MD, MSc, FRCSC1
[+] Author Affiliations
1Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
2Center for Research and Evaluation, Kaiser Permanente Regional Offices, Pasadena, California
JAMA Surg. 2013;148(9):867-872. doi:10.1001/jamasurg.2013.3033.
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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.

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Figure.
Kaplan-Meier Curve of Time to Recurrence of Acute Gallstone Pancreatitis in Patients Without Cholecystectomy

Log-rank test comparing patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and those with no intervention (P < .001).

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