EFFECT OF ENDOSCOPIC SPHINCTEROTOMY AND INTERVAL CHOLECYSTECTOMY ON LATE OUTCOME AFTER GALLSTONE PANCREATITIS

Background Endoscopic sphincterotomy alone, or followed by cholecystec tomy, are options in patients with gallstone pancreatitis. Methods Nin ety-six patients of median age 74 (range 30-93) years with gallstone p ancreatitis had endoscopic retrograde cholangiography and were followe d for a median of 84 (range 33-168) months. Forty-eight of 49 patients with, and nine of 47 without, common bile duct (CBD) stones had urgen t endoscopic sphincterotomy. One patient with, and six without, CBD st ones had delayed endoscopic sphincterotomy a median of 35 (range 12-11 1) days after acute pancreatitis. Thus, 64 patients had endoscopic sph incterotomy (group 1) and 32 did not (group 2). Fifteen and 16 patient s in each group respectively had interval cholecystectomy after a medi an of 3 months and 1 month. Results Patients in groups 1 and 2 had sim ilar rates of interval cholecystectomy (15 of 64 versus 16 of 32 patie nts respectively) or required cholecystectomy (15 of 49 versus five of 16 patients), recurrent CBD calculi (three of 64 versus three of 32 p atients) or total length of hospitalization after interval cholecystec tomy (median 15.5 and 15 days) or required (median 22 and 24 days) cho lecystectomy. The overall incidence of recurrent pancreatitis was one of 64 patients in group 1 and five of 32 in group 2 (P = 0.02), but af ter interval cholecystectomy the recurrence rate of biliopancreatic sy mptoms was similar (one of 15 patients versus three of 16 patients res pectively). Conclusion Endoscopic sphincterotomy, but not interval cho lecystectomy, reduced the overall incidence of recurrent pancreatitis, but not Of late biliary complications. Some 31 per cent of the patien ts required cholecystectomy, suggesting that routine cholecystectomy s hould be considered in fit patients following acute pancreatitis.