ENDOSCOPIC SPHINCTEROTOMY FOR BILIARY PANCREATITIS - AN ALTERNATIVE TO CHOLECYSTECTOMY IN HIGH-RISK PATIENTS

Recurrent biliary pancreatitis frequently is associated with an intact gallbladder containing stones. This condition has been effectively tr eated by removing the gallbladder, but there is evidence that endoscop ic sphincterotomy might obviate the need for cholecystectomy in some p atients. We performed prophylactic sphincterotomy in 49 patients who p resented with biliary pancreatitis more than once and who were conside red at risk for surgery. The majority (39 patients) were treated elect ively after resolution of pancreatitis, while the remainder (10 patien ts) were treated urgently during their index admission because of cont inuing symptoms. No patient experienced recurrent pancreatitis over a mean follow-up period of 48 months. No mortality occurred in this endo scopic series, and no significant morbidity was experienced. Based on our results, we advocate performing sphincterotomy in the aged patient or younger patients considered at high risk for surgery who present w ith a history of recurrent pancreatitis and cholelithiasis.