Roles of endoscopic sphincterotomy and cholecystectomy in acute biliary pancreatitis.

BACKGROUND/AIMS: We evaluated the natural course of biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy.

METHODOLOGY: The medical records of 113 patients with biliary pancreatitis between January 1990 and April 2005 were analyzed retrospectively.

RESULTS

Twenty-five patients received no treatment and 15 (60.0%) of these experienced recurrence during a mean follow-up period of 36.0 months. Fifty-two received EST only, and no recurrence occurred during a mean follow-up of 29.8 months. Thirty-six patients underwent cholecystectomy and 1 (2.8%) patient experienced the second attack during a follow-up of 35.2 months. Acute cholecystitis developed in 7 of 77 (9.1%) patients who did not receive cholecystectomy during a mean follow-up period of 33.3 months, and was found to be prone to develop in patients with both gall bladder (GB) and common bile duct (CBD) stones.

CONCLUSIONS

Sixty percent of patients with biliary pancreatitis experienced relapses without treatment, and cholecystectomy with or without EST tended to reduce recurrence. Cholecystectomy might not be a routine treatment after EST especially in the old because the incidence of acute cholecystitis was relatively low within 3 years and be recommended for patients with both visible GB and CBD stones at presentation.