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ERCP and endoscopic sphincterotomy (ES): a safe and definitive management of gallstone pancreatitis with the gallbladder left in situ

Mark Bignell, Matthew Dearing, Andrew Hindmarsh, Michael Rhodes
Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2011, 15 (12): 2205-10
22005898

BACKGROUND AND AIMS: UK guidelines recommend that patients with gallstone pancreatitis have cholecystectomy within 2 weeks of their pancreatitis. A proportion of these are elderly with significant comorbidities rendering them high risk for general anaesthesia and surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) may offer a safe alternative to cholecystectomy as definitive treatment in these patients.

PATIENTS AND METHODS: A retrospective review of all cases of gallstone pancreatitis presenting between 1999 and 2009 was undertaken.

RESULTS: One hundred one patients underwent ERCP and ES as a definitive treatment for gallstone pancreatitis with a median age of 78 years (range, 43-96 years) and a median American Society of Anesthesiologists grade of 2. Three patients died from pancreatitis despite successful ERCP. Eighty-nine patients were successfully treated with an ERCP alone, and 84 patients (94%) had no recurrence of pancreatitis with a mean follow-up of 41 months (±32 months, range 4-118 months). The total patient follow-up was 3,260 months. Twenty-seven patients (33%) died within the follow-up period of unrelated causes, explaining the lower than expected median follow-up. Five patients had a recurrence of pancreatitis during follow-up (6%).

CONCLUSION: ERCP with ES is a safe alternative to laparoscopic cholecystectomy to prevent further attacks of gallstone pancreatitis in high-risk surgical patients and the elderly.

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