Gallstone pancreatitis: positive correlation between severe pancreatitis and passed stone.

BACKGROUND/PURPOSE: Little is known about whether the severity of pancreatitis depends upon persistent stone impaction or stone passage into the duodenum, and the role of endoscopic sphincterotomy (ES) has remained controversial.

METHODS

This study reviewed our experience of 183 patients with gallstone pancreatitis, with special attention paid to the relationship between the severity of pancreatitis, the severity of coexisting biliary pathology, and the outcome.

RESULTS

Sixteen patients (9%) had severe pancreatitis (SP) and the remaining 167 (91%) had mild pancreatitis (MP). All of the SP patients had pancreatic necrosis, and 6 of them developed multiple organ failure (MOF). No SP patients had stones impacted at the papilla of Vater or persistent stones and purulent bile in the bile duct (severe cholangitis). Most SP patients (94%) had stones in the gallbladder alone, suggesting stone passage into the duodenum. Of the 167 MP patients, on the other hand, 58 (35%) had severe cholangitis. Four patients (25%) with SP died of MOF. There were four deaths in the MP group (2%) and all in patients with coexisting severe cholangitis, 2 of whom were in septic shock at the time of admission.

CONCLUSIONS

None of the SP patients had severe cholangitis. The positive correlation between SP and passed stone suggests that early ES should not be advocated for SP patients. MP patients with coexisting severe cholangitis are likely to benefit from ES.