Endoscopic retrograde cholangio-pancreatograhy and laparoscopic cholecystectomy in single session management of acute biliary pancreatitis

Background: World widely, the annual incidence of acute pancreatitis ranges from 5 to 50 per 100000. The major cause of acute pancreatitis is biliary calculi, which occur in 50-70% of patients. Aim of this study is to evaluate Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) as a single step management of early acute biliary pancreatitis.Methods: A prospective study included 25 patients complaining of acute biliary pancreatitis. The study was done between December 2012 and February 2016 at Menofia University Hospital. All patients had acute biliary pancreatitis with obstructive jaundice proved by laboratory investigations and imaging. ERCP and LC in the same session were aimed in all patients. Results: Successful same session was done in 24 (96%) cases and 1 (4%) case failed (just had ERCP only). Twenty cases (80%) were females and five cases (20%) were males. By ERCP, multiple small stones were extracted in 15 (60%) cases, biliary mud in 3 (12%) cases, a big stone in 2 (8%) cases and no stones were extracted in 5 (20%) cases. During laparoscopic cholecystectomy, bile stained ascites was present in 15 (60%) cases and absent in 9 (36%) cases. Calcium soap in 7 (28%) cases and absent in 17 (68%) cases. 17 (68%) patients stayed 24 hours in hospital while 6 (24%) patients stayed 48 hours and 2 (8%) cases stayed 72 hours. No mortality was recorded.Conclusions: ERCP and LC as a single step is a good option for management of early acute biliary pancreatitis.

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Gall Stones in Acute Pancreatitis - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/553 ◽

2020 ◽

Vol 7 (46) ◽

pp. 2690-2693

Author(s):

Venkata Prakash Gandikota ◽

Tharaka Mourya Nutulapati ◽

Purushotham Gangapalli ◽

Ajay Babu Korchapati ◽

Sahithi Priya Boddukura ◽

...

Keyword(s):

Acute Pancreatitis ◽

Laparoscopic Cholecystectomy ◽

Prospective Study ◽

Hospital Stay ◽

Morbidity And Mortality ◽

Care Hospital ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Gall Stones ◽

A Prospective Study

BACKGROUND Multiple practice guidelines from different American and European societies recommend index hospitalization cholecystectomy following an episode of gallstone pancreatitis. We wanted to analyse the outcome of patients presenting with acute pancreatitis in the presence of gall stones, analyse the sensitivity and specificity of liver function tests in early prediction of acute biliary pancreatitis and establish the advantages of early intervention in acute biliary pancreatitis. METHODS This is a prospective study conducted at a tertiary care hospital for a period of 12 months among 100 cases of acute pancreatitis who presented with abdominal pain with serum amylase level 3 times the normal limits in the absence of hypercalcemia or hyperlipidaemia. Presence of gallstones was confirmed on ultrasonography. Patients were subjected to preoperative ERCP and endoscopic sphincterotomy. Intraoperative and postoperative morbidity and mortality, and postoperative hospital stay were reported. RESULTS Gall stones were the cause of pancreatitis in 16 out of 100 cases (16 %). Male to female ratio was 1 : 3. Mean occurrence of age was 51.1 years. Preoperative ERCP was done 10 cases (63 %). Laparoscopic Cholecystectomy was performed in all the 16 cases (100 %) of which 12 cases (75 %) underwent Lap cholecystectomy in the same admission and 4 cases were subjected to interval cholecystectomy. 1 case was converted to open procedure. Post-operative complications include nausea and vomiting in 2 cases, chest infection in 2 and bile leak in 1. CONCLUSIONS Management of acute pancreatitis in the presence of gallstones requires prompt diagnosis and timely intervention. Laparoscopic cholecystectomy can be safely performed for mild to moderate acute biliary pancreatitis after clinical and biochemical resolution of the attack during the same admission with acceptable morbidity and mortality rates. This strategy will lead to reducing the recurring acute biliary pancreatitis, number of admissions and hospital stay. KEYWORDS Acute Pancreatitis, Gallstones, LFT, Lipase, Amylase, ERCP, Laparoscopic Cholecystectomy

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Interval Laparoscopic Cholecystectomy in the Management of Acute Biliary Pancreatitis

HPB Surgery ◽

10.1155/2000/40290 ◽

2000 ◽

Vol 11 (5) ◽

pp. 319-323 ◽

Cited By ~ 22

Author(s):

M. D. Pinhas Schachter ◽

M. D. Timor Peleg ◽

M. D. Oded Cohen

Keyword(s):

Acute Pancreatitis ◽

Laparoscopic Cholecystectomy ◽

Traditional Approach ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Operating Time ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Calot’S Triangle ◽

Mild Acute Pancreatitis

The timing of laparoscopic cholecystectomy following an attack of acute biliary pancreatitis is controversial. The traditional approach of interval cholecystectomy has been challenged recently. The present study was designed to evaluate the benefits of interval laparoscopic cholecystectomy for patients with mild acute pancreatitis (Ranson less than 3). Nineteen patients with mild pancreatitis underwent ultrasonographic evaluation to confirm the biliary etiology. ERCP was performed in all patients on the first available endoscopy list, and endoscopic sphincterotomy was performed in two patients with calculi or dilated common bile duct on ultrasonographic examination. Medical treatment was administered and laparoscopic cholecystectomy was scheduled after 8–12 weeks to allow the inflammatory process to settle. There were no recurrent attacks of pancreatitis during this period. The degree of difficulty of the laparoscopic procedure was assessed by the presence of adhesions to the gallbladder area, difficulty of dissection in the Calot's triangle, intraoperative bleeding and the need for a drain. Six patients (31.5%) had severe adhesions, difficult dissection of the cystic duct and artery, bleeding and prolonged operating time. In two of these patients (10.5%) the procedure was converted to open cholecystectomy. In conclusion, our results suggest that postponing laparoscopic cholecystectomy in acute pancreatitis patients is not advantageous surgically and does not justify the risk of further morbidity caused by the gallbladder disease.

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Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis

10.5772/intechopen.96545 ◽

2021 ◽

Author(s):

Ülkü Saritaş ◽

Yücel Üstündağ

Keyword(s):

Acute Pancreatitis ◽

Supportive Therapy ◽

Severe Form ◽

Fluid Replacement ◽

Biliary Pancreatitis ◽

Endoscopic Retrograde ◽

Acute Biliary Pancreatitis ◽

Mild Disease ◽

Severe Pancreatitis ◽

Short Time

Acute pancreatitis (AP) is the most serious emergent disease in the gastroenterology field. The most common cause of AP is naturally gallstones. The most cases have mild disease and the illness limits itself in a short time period. In 15–20% of cases, the severe form of acute biliary pancreatitis (ABP) develops. Some patients have concomitant cholangitis. In these patients, releiving biliary obstruction with endoscopic retrograde cholangiography (ERCP) and endoscopic sphincterotomy (ES) is essential. However, correct timing of ERCP is a debate. While some authors and guidelines suggested that ERCP can be performed in first 24 hours, the others suggested its use during the first 72 hours. In the first 24 hours, ERCP is diffucult to apply due to ampullary edema and general ill situation of the patient. Rather than ERCP, agressive fluid replacement and supportive therapy are very much important in the first 72 hours of admission. Moreover, there is no consensus on timing of ERCP in patients with severe pancreatitis without cholangitis. But all international guidelines suggested that ERCP should be perfomed in all patients with mild or severe pancreatitis together with concomitant cholangitis during the first 72 hours. After resolution of ABP, cholecystectomy should be performed to prevent recurrent pancreatitis during the same hospitalization period (index cholecystectomy). If the patient is not suitable for cholecystectomy, ERCP and ES should be done to prevent further attacks of acute pancreatitis.

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Surgical treatment of acute biliary pancreatitis

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2021-180-1-40-44 ◽

2021 ◽

Vol 180 (1) ◽

pp. 40-44

Author(s):

A. Yu. Korolkov ◽

A. A. Smirnov ◽

D. N. Popov ◽

M. M. Saadylaeva ◽

T. O. Nikitina ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Single Step ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Surgical Interventions ◽

Delayed Laparoscopic Cholecystectomy ◽

Pancreatic Duct Stenting

The objective was to improve the management of patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis.Methods and materials. 107 patients with acute biliary pancreatitis against the background of cholecystocholedocholithiasis were treated between 2017 and 2020 years. Patients suffering from mild and moderately severe acute biliary pancreatitis underwent single-step (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) or two-step (endoscopic papillosphincterotomy with delayed laparoscopic cholecystectomy) surgical interventions. Patients with severe acute pancreatitis underwent endoscopic papillosphincterotomy with or without common bile duct and pancreatic duct stenting. The comparative analysis was made to estimate the efficiency of different surgical interventions in different groups of patients.Results. Patients with mild or moderately severe acute biliary pancreatitis showed better outcomes after single-step surgical intervention. Patients with severe acute biliary pancreatitis – after endoscopic papillosphincterotomy with common bile duct and pancreatic duct stenting.Conclusion. Single-step surgical interventions (laparoscopic cholecystectomy with endoscopic papillosphincterotomy) are shown for patients with mild or moderately severe acute biliary pancreatitis, because this approach helps to preserve the complications, specific for two-step interventions. The single-step approach authentically helps to decrease the duration of hospital stay and reduce treatment costs. The two-step approach is shown for patients with severe acute biliary pancreatitis, but endoscopic papillosphincterotomy with lithoextraction should be supplemented by common bile duct and pancreatic duct stenting, in order to reduce the number of complications associated with delayed cholecystectomy.

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