Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)

Pandanaboyana Sanjay, Sim Yeeting, Carole Whigham, Hannah Judson, Francesco M. Polignano, Iain S. Tait

    Research output: Contribution to journalArticle

    24 Citations (Scopus)

    Abstract

    Background UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2 weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.

    Methods All patients that presented with GSP over a 4-year period (2002-2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.

    Results 100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58%) had an index cholecystectomy, and 38 (42%) an interval cholecystectomy.

    Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2-30) days for index cholecystectomy and 63 (13-210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5%) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.

    Conclusions This study demonstrates that overall 62% (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.

    Original languageEnglish
    Pages (from-to)1832-1837
    Number of pages6
    JournalSurgical Endoscopy
    Volume22
    Issue number8
    DOIs
    Publication statusPublished - Aug 2008

    Keywords

    • index
    • interval
    • gallstone
    • pancreatitis
    • cholecystectomy
    • ACUTE BILIARY PANCREATITIS
    • LAPAROSCOPIC CHOLECYSTECTOMY
    • CONSERVATIVE TREATMENT
    • MANAGEMENT
    • SURGERY
    • MILD
    • PAPILLOTOMY
    • TRIAL
    • TRACT
    • AUDIT

    Cite this

    Sanjay, Pandanaboyana ; Yeeting, Sim ; Whigham, Carole ; Judson, Hannah ; Polignano, Francesco M. ; Tait, Iain S. / Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP). In: Surgical Endoscopy. 2008 ; Vol. 22, No. 8. pp. 1832-1837.
    @article{391432be512845e886707a41f6684b2d,
    title = "Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)",
    abstract = "Background UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2 weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.Methods All patients that presented with GSP over a 4-year period (2002-2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.Results 100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58{\%}) had an index cholecystectomy, and 38 (42{\%}) an interval cholecystectomy.Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2-30) days for index cholecystectomy and 63 (13-210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5{\%}) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.Conclusions This study demonstrates that overall 62{\%} (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.",
    keywords = "index, interval, gallstone, pancreatitis, cholecystectomy, ACUTE BILIARY PANCREATITIS, LAPAROSCOPIC CHOLECYSTECTOMY, CONSERVATIVE TREATMENT, MANAGEMENT, SURGERY, MILD, PAPILLOTOMY, TRIAL, TRACT, AUDIT",
    author = "Pandanaboyana Sanjay and Sim Yeeting and Carole Whigham and Hannah Judson and Polignano, {Francesco M.} and Tait, {Iain S.}",
    year = "2008",
    month = "8",
    doi = "10.1007/s00464-007-9710-1",
    language = "English",
    volume = "22",
    pages = "1832--1837",
    journal = "Surgical Endoscopy",
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    }

    Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP). / Sanjay, Pandanaboyana; Yeeting, Sim; Whigham, Carole; Judson, Hannah; Polignano, Francesco M.; Tait, Iain S.

    In: Surgical Endoscopy, Vol. 22, No. 8, 08.2008, p. 1832-1837.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Endoscopic sphincterotomy and interval cholecystectomy are reasonable alternatives to index cholecystectomy in severe acute gallstone pancreatitis (GSP)

    AU - Sanjay, Pandanaboyana

    AU - Yeeting, Sim

    AU - Whigham, Carole

    AU - Judson, Hannah

    AU - Polignano, Francesco M.

    AU - Tait, Iain S.

    PY - 2008/8

    Y1 - 2008/8

    N2 - Background UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2 weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.Methods All patients that presented with GSP over a 4-year period (2002-2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.Results 100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58%) had an index cholecystectomy, and 38 (42%) an interval cholecystectomy.Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2-30) days for index cholecystectomy and 63 (13-210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5%) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.Conclusions This study demonstrates that overall 62% (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.

    AB - Background UK guidelines for gallstone pancreatitis (GSP) advocate definitive treatment during the index admission, or within 2 weeks of discharge. However, this target may not always be achievable. This study reviewed current management of GSP in a university hospital and evaluated the risk associated with interval cholecystectomy.Methods All patients that presented with GSP over a 4-year period (2002-2005) were stratified for disease severity (APACHE II). Patient demographics, time to definitive therapy [index cholecystectomy; endoscopic sphincterotomy (ES); Interval cholecystectomy], and readmission rates were analysed retrospectively.Results 100 patients admitted with GSP. Disease severity was mild in 54 patients and severe in 46 patients. Twenty-two patients unsuitable for surgery underwent ES as definitive treatment with no readmissions. Seventy-eight patients underwent cholecystectomy, of which 40 (58%) had an index cholecystectomy, and 38 (42%) an interval cholecystectomy.Only 10 patients with severe GSP had an index cholecystectomy, whilst 30 were readmitted for Interval cholecystectomy (p = 0.04). The median APACHE score was 4 [standard deviation (SD) 3.8] for index cholecystectomy and 8 (SD 2.6) for Interval cholecystectomy (p < 0.05). Median time (range) to surgery was 7.5 (2-30) days for index cholecystectomy and 63 (13-210) days for Interval cholecystectomy. Fifty percent (19/38) of patients with GSP had ES prior to discharge for interval cholecystectomy. Two (5%) patients were readmitted: with acute cholecystitis (n = 1) and acute pancreatitis (n = 1) , whilst awaiting interval cholecystectomy. No mortality was noted in the Index or Interval group.Conclusions This study demonstrates that overall 62% (22 endoscopic sphincterotomy and 40 index cholecystectomy) of patients with GSP have definitive therapy during the Index admission. However, surgery was deferred in the majority (n = 30) of patients with severe GSP, and 19/30 underwent ES prior to discharge. ES and interval cholecystectomy in severe GSP is associated with minimal morbidity and readmission rates, and is considered a reasonable alternative to an index cholecystectomy in patients with severe GSP.

    KW - index

    KW - interval

    KW - gallstone

    KW - pancreatitis

    KW - cholecystectomy

    KW - ACUTE BILIARY PANCREATITIS

    KW - LAPAROSCOPIC CHOLECYSTECTOMY

    KW - CONSERVATIVE TREATMENT

    KW - MANAGEMENT

    KW - SURGERY

    KW - MILD

    KW - PAPILLOTOMY

    KW - TRIAL

    KW - TRACT

    KW - AUDIT

    U2 - 10.1007/s00464-007-9710-1

    DO - 10.1007/s00464-007-9710-1

    M3 - Article

    VL - 22

    SP - 1832

    EP - 1837

    JO - Surgical Endoscopy

    JF - Surgical Endoscopy

    SN - 0930-2794

    IS - 8

    ER -