Abstract
Background
Population aging and comorbidity are leading to an increase in patients unfit for
cholecystectomy.
Aims
To evaluate whether endoscopic biliary sphincterotomy after a first episode of acute
gallstone pancreatitis reduces the risk of pancreatitis recurrence and gallstone-related
events in non-surgical candidates.
Methods
Retrospective study of patients admitted for a first episode of acute gallstone pancreatitis
rejected for cholecystectomy between 2013–2018. The role of endoscopic sphincterotomy
was evaluated by adjusting for age, severity of pancreatitis, and presence of choledocholithiasis.
Results
We included 247 patients (mean age 80 ± 12 years; Charlson index: 5; severity of pancreatitis:
72% mild). Sphincterotomy was performed in 23.9%. Recurrence of pancreatitis occurred
in 17.4% patients (median follow-up: 426 days). The one-year cumulative incidence
of a new episode of pancreatitis was 1.8% (95% confidence interval [CI]: 0.2–12%)
and 23% (95% CI: 17–31%) in patients with and without sphincterotomy, respectively
(p = 0.006). In multivariate analysis, sphincterotomy showed a protective role for
recurrence of pancreatitis (adjusted hazard ratio [HR]: 0.29, 95% CI: 0.08–0.92, p = 0.037)
and for any gallstone-related event (HR 0.46, 95% CI: 0.21–0.98, p = 0.043).
Conclusions
Endoscopic biliary sphincterotomy reduced the risk of gallstone pancreatitis recurrence
and other biliary-related disorders in patients with a first episode of pancreatitis
non-candidates for cholecystectomy.
Keywords
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Article info
Publication history
Published online: May 28, 2019
Footnotes
☆Presented as an abstract at 40 Congreso Sociedad Española de Endoscopia Digestiva (SEED), Zaragoza, Spain, November 2018.
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
