Gastroenterology · Surgery · 2 h ago
Cholecystectomy not linked to fewer events after gallstone-related pancreatic necrosis
A retrospective cohort study of 113 patients with gallstone-induced acute pancreatitis and walled-off necrosis found no statistically significant association between cholecystectomy or biliary sphincterotomy and recurrent pancreatitis or biliary events. The findings concern a selected population after endoscopic treatment and do not establish that either procedure is ineffective.
- Cohort included 113 patients with gallstone-induced pancreatitis and WON.
- Fourteen patients experienced recurrent acute pancreatitis.
- Neither procedure was significantly associated with study outcomes.
- Retrospective design and wide confidence intervals limit certainty.
Cholecystectomy is generally recommended after gallstone-induced acute pancreatitis, but its role after development of walled-off pancreatic necrosis (WON) is uncertain. Researchers retrospectively evaluated 113 consecutive patients treated for gallstone-induced pancreatitis with symptomatic WON, assessing recurrent acute pancreatitis and biliary events in relation to cholecystectomy and biliary sphincterotomy (BS).
Acute pancreatitis recurred in 14 patients. Recurrence was associated with younger age (mean 47.5 vs 61.0 years; p=0.0079) and a lower Charlson Comorbidity Index (0.5 vs 2.0; p=0.0090). Recurrence risk did not differ significantly by cholecystectomy status (HR 2.97, 95% CI 0.80–10.94; p=0.103) or BS status (HR 0.75, 95% CI 0.26–2.17; p=0.597). Neither procedure was significantly associated with biliary events or the combined endpoint of recurrence or a biliary event.
These retrospective results do not demonstrate a reduction in events associated with either intervention in this specific population; they also do not show that the procedures have no benefit. The wide confidence intervals and small number of recurrences limit precision. The findings should not be taken as evidence to change usual management based on this cohort alone.
In practice
For patients with gallstone-induced acute pancreatitis complicated by symptomatic walled-off necrosis who underwent endoscopic treatment, this retrospective cohort found no statistically significant association between cholecystectomy or biliary sphincterotomy and recurrent pancreatitis or biliary events. The result does not establish that either procedure is ineffective or support changing practice: only 14 recurrences occurred, confidence intervals were wide, and treatment was not randomized. Applicability is limited to this selected cohort and should be weighed against existing management recommendations and other evidence.
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Surgical Endoscopy: Impact of cholecystectomy and biliary sphincterotomy on recurrent acute pancreatitis and biliary events after endoscopic treatment of gallstone-induced walled-off pancreatic necrosis: a retrospective cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.