Objective:

To evaluate the impact of same-admission cholecystectomy on recurrent pancreatitis and gallstone-related complications in patients with presumed mild gallstone-related acute pancreatitis.

Approach:

• Study Design: Analysis of the Swedish Pancreatitis (SwePan) registry involving 9,593 adults hospitalized with a first episode of gallstone-related acute pancreatitis from 2006 to 2019.
• Patient Grouping: Patients were grouped based on index-admission management: cholecystectomy with or without ERCP, ERCP alone, or no intervention.
• Outcomes Measured: Primary outcome was recurrent acute pancreatitis; secondary outcomes included other gallstone-related complications.
• Statistical Analysis: Analyses adjusted for demographic characteristics, socioeconomic factors, comorbidities, and accounted for death as a competing event.

Key Findings:

• 3% of patients who underwent cholecystectomy experienced recurrent acute pancreatitis compared to 5% with ERCP alone and 18% with no intervention.
• Other gallstone-related complications occurred in 2% of cholecystectomy patients, 20% of ERCP patients, and 16% of those with no intervention.
• No intervention was associated with a sixfold higher risk of recurrent pancreatitis compared to same-admission cholecystectomy.
• ERCP alone showed a modestly higher risk of recurrence primarily within the first 2 weeks post-discharge.
• Elective cholecystectomy after discharge led to more recurrent pancreatitis than same-admission cholecystectomy.

Limitations:

• Observational design may introduce residual confounding and selection bias.
• Patients treated with ERCP alone were generally older and had more comorbidities.
• Lack of detailed clinical information on disease severity and other relevant factors.
• Exclusion of patients with presumed severe pancreatitis may not fully represent the population.

Sources:

• JAMA Surgery