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ERCP reduced risk for recurrence of gallstone pancreatitis
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Patients with acute gallstone pancreatitis were less likely to experience recurrence if they underwent endoscopic retrograde cholangiopancreatography in a recent study.
In a retrospective cohort study, researchers evaluated 1,119 Kaiser Permanente Southern California members with acute gallstone pancreatitis hospitalized between January 1995 and December 2010, with a median follow-up of 2.3 years. No participants had prior diagnoses of gallstone pancreatitis or previously had received cholecystectomy upon hospitalization.
The cohort included 802 patients who received no intervention and 317 who underwent endoscopic retrograde cholangiopancreatography (ERCP). Overall, 14.6% of participants developed recurrent pancreatitis, including 8.2% of those who underwent ERCP and 17.1% of those who did not (P<.001 for difference). A median of 11.3 months to recurrence was observed in the ERCP group, compared with 10.1 months in the nonintervention group. The length of initial hospital stay was longer among patients in the ERCP group (4 days vs. 3 days; P<.001).
Investigators estimated recurrence risks of 5.2% at 1 year, 7.4% at 2 years and 11.1% at 5 years among ERCP recipients and 11.3%, 16.1% and 22.7%, respectively, in the group without intervention. ERCP was independently associated with reduced risk for recurrent pancreatitis (adjusted HR=0.45; 95% CI, 0.3-0.69), while ICU stay (aHR=2.55; 95% CI, 1.28-5.07) and one or more comorbidities (aHR=1.67; 95% CI, 1.17-2.4) increased the risk for recurrence.
Philip I. Haigh
“Patients who are admitted to the hospital with gallstone pancreatitis, if their medical condition permits, should have cholecystectomy early, because the risk of recurrent pancreatitis is high if surgery is not done,” researcher Philip I. Haigh, MD, MSc, department of surgery at Kaiser Permanente Los Angeles Medical Center, told Healio.com. “However, if unable to undergo cholecystectomy, then an ERCP should be considered, which decreases the recurrence risk approximately by 50%.”
Disclosure: The researchers report no relevant financial disclosures.
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