BACKGROUND: Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. METHODS: A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. RESULT: Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks. CONCLUSION: From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.
BACKGROUND: Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. METHODS: A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. RESULT: Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks. CONCLUSION: From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.
Authors: Martin A Makary; Mark D Duncan; John W Harmon; Paul D Freeswick; Jeffrey S Bender; Mark Bohlman; Thomas H Magnuson Journal: Ann Surg Date: 2005-01 Impact factor: 12.969
Authors: Christina J Sperna Weiland; Evelien C Verschoor; Alexander C Poen; Xavier J M N Smeets; Niels G Venneman; Abha Bhalla; Ben J M Witteman; Hester C Timmerhuis; Devica S Umans; Jeanin E van Hooft; Marco J Bruno; P Fockens; Robert C Verdonk; Joost P H Drenth; Erwin J M van Geenen Journal: Surg Endosc Date: 2022-09-26 Impact factor: 3.453
Authors: Stefan A Bouwense; Marc G Besselink; Sandra van Brunschot; Olaf J Bakker; Hjalmar C van Santvoort; Nicolien J Schepers; Marja A Boermeester; Thomas L Bollen; Koop Bosscha; Menno A Brink; Marco J Bruno; Esther C Consten; Cornelis H Dejong; Peter van Duijvendijk; Casper H van Eijck; Jos J Gerritsen; Harry van Goor; Joos Heisterkamp; Ignace H de Hingh; Philip M Kruyt; I Quintus Molenaar; Vincent B Nieuwenhuijs; Camiel Rosman; Alexander F Schaapherder; Joris J Scheepers; Marcel B W Spanier; Robin Timmer; Bas L Weusten; Ben J Witteman; Bert van Ramshorst; Hein G Gooszen; Djamila Boerma Journal: Trials Date: 2012-11-26 Impact factor: 2.279
Authors: Antonios Vezakis; Andreas Polydorou; Elissaios Kontis; Eirini Pantiora; Ioannis S Papanikolaou; Georgios Fragulidis Journal: Ann Gastroenterol Date: 2017-10-26