BACKGROUND AND AIMS: UK guidelines recommend that patients with gallstone pancreatitis have cholecystectomy within 2 weeks of their pancreatitis. A proportion of these are elderly with significant comorbidities rendering them high risk for general anaesthesia and surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) may offer a safe alternative to cholecystectomy as definitive treatment in these patients. PATIENTS AND METHODS: A retrospective review of all cases of gallstone pancreatitis presenting between 1999 and 2009 was undertaken. RESULTS: One hundred one patients underwent ERCP and ES as a definitive treatment for gallstone pancreatitis with a median age of 78 years (range, 43-96 years) and a median American Society of Anesthesiologists grade of 2. Three patients died from pancreatitis despite successful ERCP. Eighty-nine patients were successfully treated with an ERCP alone, and 84 patients (94%) had no recurrence of pancreatitis with a mean follow-up of 41 months (±32 months, range 4-118 months). The total patient follow-up was 3,260 months. Twenty-seven patients (33%) died within the follow-up period of unrelated causes, explaining the lower than expected median follow-up. Five patients had a recurrence of pancreatitis during follow-up (6%). CONCLUSION: ERCP with ES is a safe alternative to laparoscopic cholecystectomy to prevent further attacks of gallstone pancreatitis in high-risk surgical patients and the elderly.
BACKGROUND AND AIMS: UK guidelines recommend that patients with gallstone pancreatitis have cholecystectomy within 2 weeks of their pancreatitis. A proportion of these are elderly with significant comorbidities rendering them high risk for general anaesthesia and surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) may offer a safe alternative to cholecystectomy as definitive treatment in these patients. PATIENTS AND METHODS: A retrospective review of all cases of gallstone pancreatitis presenting between 1999 and 2009 was undertaken. RESULTS: One hundred one patients underwent ERCP and ES as a definitive treatment for gallstone pancreatitis with a median age of 78 years (range, 43-96 years) and a median American Society of Anesthesiologists grade of 2. Three patients died from pancreatitis despite successful ERCP. Eighty-nine patients were successfully treated with an ERCP alone, and 84 patients (94%) had no recurrence of pancreatitis with a mean follow-up of 41 months (±32 months, range 4-118 months). The total patient follow-up was 3,260 months. Twenty-seven patients (33%) died within the follow-up period of unrelated causes, explaining the lower than expected median follow-up. Five patients had a recurrence of pancreatitis during follow-up (6%). CONCLUSION: ERCP with ES is a safe alternative to laparoscopic cholecystectomy to prevent further attacks of gallstone pancreatitis in high-risk surgical patients and the elderly.
Authors: Djemila Boerma; Erik A J Rauws; Yolande C A Keulemans; Ignace M C Janssen; Clemens J M Bolwerk; Ron Timmer; Egge J Boerma; Huug Obertop; Kees Huibregtse; Dirk J Gouma Journal: Lancet Date: 2002-09-07 Impact factor: 79.321
Authors: Beat Gloor; Philip F Stahel; Christoph A Müller; Mathias Worni; Markus W Büchler; Waldemar Uhl Journal: J Gastrointest Surg Date: 2003 Mar-Apr Impact factor: 3.452
Authors: Birger Sandzén; Markku M Haapamäki; Erik Nilsson; Hans C Stenlund; Mikael Oman Journal: BMC Gastroenterol Date: 2009-10-23 Impact factor: 3.067
Authors: Abdalla Mustafa; Irena Begaj; Mark Deakin; Damien Durkin; David J Corless; Richard Wilson; John P Slavin Journal: Surg Endosc Date: 2013-08-28 Impact factor: 4.584