Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis?

Ki Bae Bang; Hong Joo Kim; Yong Kyun Cho; Woo Kyu Jeon

doi:10.4166/kjg.2015.65.5.297

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Bang, Kim, Cho, and Jeon: Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis?

Original Article

Korean J Gastroenterol 2015;65(5):297-305.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.5.297

Does Endoscopic Sphincterotomy and/or Cholecystectomy Reduce Recurrence Rate of Acute Biliary Pancreatitis?

Ki Bae Bang, Hong Joo Kim, Yong Kyun Cho, Woo Kyu Jeon

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Hong Joo Kim, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea. Tel: +82-2-2001-8556, Fax: +82-2-2001-8340, E-mail: ringer2003@gmail.com

Received 5 December 201411 March 2015 Accepted 16 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Practice guidelines from international societies have recommended cholecystectomy during the same hospitalization for acute biliary pancreatitis (ABP). The aim of this study is to investigate the question of whether endoscopic sphincterotomy (EST) and/or cholecystectomy during the same hospitalization can reduce the recurrence rate of ABP.

Methods

A total of 119 patients with ABP admitted to our institution between May 2005 and May 2010 who had complete follow-up data until May 2012 were enrolled.

Results

No significant differences in initial CT severity index and Charlson comorbidity index were observed between EST (n=64) and non-EST group (n=55) and among subgroups classified according to interventions performed. In Kaplan-Meier analyses, significantly higher recurrence rates of ABP were observed in the non-EST group compared to the EST group (p<0.01), and in the conservative treatment group compared to other intervention groups (p<0.01). The frequency of complications from ABP was significantly higher in the conservative treatment group (35.7%) and lowest in the EST plus cholecystectomy group (5.0%, p=0.008). In multivariate analysis, conservative treatment without EST and/or cholecystectomy, and non-EST group were independent risk factors for recurrence after the initial attack of ABP.

Conclusions

ERCP with EST and cholecystectomy during the index admission is associated with reduced recurrence rates of ABP.

Keywords: Acute biliary pancreatitis, Recurrence, Endoscopic sphincterotomy, Cholecystectomy

References

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Fig. 1.

The process for selection of our enrolled patients.

Fig. 2.

Fifteen patients (12.6%) experienced recurrences of acute biliary pancreatitis (ABP) during the follow-up period. By Kaplan-Meier analyses with log rank comparison, recurrence rates of ABP were significantly higher in the non-endoscopic sphincterotomy (EST) group compared to the EST group (p<0.01), and in the conservative treatment group compared to other intervention groups by log rank comparisons (p<0.01). CBD, common bile duct.

Fig. 3.

(A) Time to recovery from ABP (days) was significantly longer in the non-endoscopic sphincterotomy (EST) group compared to the EST group (5.0±3.0 vs. 2.4±1.3; p<0.001). (B) Among the groups of patients classified according to the interventions performed, the conservative treatment group and cholecystectomy only group were associated with significantly longer recovery time from ABP (days) compared with the EST plus cholecystectomy group and EST only group by post hoc tests (5.4±3.9 and 4.8±2.7 vs. 2.2±1.0 and 2.8±1.6, respectively; p<0.01). (C) The length of hospital stay (days) was significantly longer in the non-EST group compared to the EST group (15.0±22.8 vs. 4.4±2.2, respectively; p<0.01). (D) By post hoc tests, the conservative treatment group and cholecystectomy only group were associated with significantly longer hospital stay (days) compared with the EST plus cholecystectomy group and EST only group (15.1±14.6 and 15.0±25.1 vs.3.8±1.4 and 5.4±2.8, respectively; p<0.01).

Fig. 4.

Complication rates. (A) Three patients (4.7%) in the endoscopic sphincterotomy (EST) group and 11 patients (20.0%) in the non-EST group experienced complications of acute biliary pancreatitis (ABP) defined in the current study. Significantly higher occurrence rates of complications of ABP were observed in the non-EST group compared to the EST group (p=0.02). (B) Significantly higher complications rates were observed in the conservative treatment group (35.7%) and the lowest in the EST plus cholecystectomy group (5.0%, p=0.008).

Table 1.

Demographics and Clinical Characteristics of the Study Participants

Characteristic	Total patients (n=119)	Group		p-value	Group				p-value
Characteristic	Total patients (n=119)	EST (n=64)	Non-EST (n=55)	p-value	EST+cholecy-stectomy (n=40)	EST only (n=24)	Cholecystectomy only (n=41)	Conservative treatment (n=14)	p-value
Age (yr)	62.0±16.5	64.5±15.0	59.1±17.8	0.076	62.6±15.4	67.8±14.0	58.8±18.3	59.9±16.9	0.189
Gender, male (%)	64 (53.8)	39 (60.9)	25 (45.5)	0.101	20 (50.0)	19 (79.2)	17 (41.5)	8 (57.1)	0.649
Follow-up (mo)	41.5±20.6	41.8±17.8	41.1±23.7	0.849	38.2±15.5	47.8±20.0	41.6±24.1	39.5±23.2	0.343
CT severity index	3.1±1.2	2.9±1.0	3.3±1.4	0.132	2.9±1.0	3.0±1.0	3.1±1.3	3.8±1.5	0.122
Charlson comorbidity index	1.4±1.5	1.4±1.7	1.3±1.2	0.511	1.3±1.7	1.8±1.8	1.0±0.7	1.9±1.9	0.117

Values are presented as mean±SD or n (%).

EST, endoscopic sphincterotomy.

Table 2.

Cox Regression Analyses for the Independent Risk Factors of Recurrence of ABP

Variable	OR	95% CI	p-value
Age ≥65 yr Gender, male	1.032 1.58	0.29-3.74 0.44-5.71	0.962 0.487
CT severity index >3	1.13	0.28-4.53	0.861
Complications of ABP (+)	1.76	0.47-6.58	0.399
Non-EST group	11.63	1.87-71.43	<0.01
Conservative treatment without EST and/or cholecystectomy	11.63	2.78-50.0	<0.01

ABP, acute biliary pancreatitis; EST, endoscopic sphincterotomy.

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