Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis
Background The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown tha...
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| Veröffentlicht in: | Surgical endoscopy 2014-12, Vol.28 (12), p.3337-3342 |
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| description | Background
The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown that these patients still benefit from cholecystectomy, the optimal timing of this intervention is not well defined. We hypothesized that delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis is associated with significant preventable morbidity.
Methods
A retrospective chart review was performed at two academic hospitals for patients diagnosed with biliary pancreatitis who underwent endoscopic sphincterotomy followed by cholecystectomy. Patients aged 18 and over admitted from 2006 to 2011 were included, while those with severe pancreatitis were excluded. The primary outcome was biliary complications experienced during the waiting period for cholecystectomy. Secondary outcomes included length of stay, operative complications, and conversion rate. Student
t
test was used to compare continuous data and Fischer’s exact test was used for categorical data.
Results
80 patient charts were reviewed. Time to cholecystectomy was 3.3 days (range 0.5–10) in the early group and 141.6 (range 18–757) in the delayed group. The groups were comparable in terms of age and American Society of Anesthesiologists (ASA) classification. 21 of 35 patients (60 %) in the delayed group experienced biliary complications compared with 1 of 45 (2 %) in the early group (
p
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| doi_str_mv | 10.1007/s00464-014-3621-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1623290226</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3490747511</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-389c972322b1a43c8741dbcfc425129eb453fdf0f61aae744d4e0059c7251dd23</originalsourceid><addsrcrecordid>eNp1kUtr3TAQhUVJaW7S_oBuiiCbbtxKI_mhZQhpGwh0066FLI0TBdlyJDvB_7663NsSAl3N4nxz5nEI-cjZF85Y-zUzJhtZMS4r0QCvujdkx6WACoB3J2THlGAVtEqekrOcH1jBFa_fkVOQqoGurndkuDYpbPQJU14zdRjMho7a-xjQbnlBu8Rxo0MMIT776Y7i5GK2cfaW5vneT3bBFI9MoqMPjvY-eJM2OpvJJjSLX3x-T94OJmT8cKzn5Pe3619XP6rbn99vri5vKyslLJXolFUtCICeGyls10ruejtYCTUHhb2sxeAGNjTcGGyldBIZq5Vti-4ciHPy-eA7p_i4Yl706LPFEMyEcc2aN8VcMYCmoBev0Ie4pqlst6cAWCNYWyh-oGyKOScc9Jz8WM7TnOl9CPoQgi4h6H0Iuis9n47Oaz-i-9fx9-sFgAOQizTdYXox-r-ufwBzAZNP</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1622206307</pqid></control><display><type>article</type><title>Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Mador, Brett D. ; Panton, O. Neely M. ; Hameed, S. Morad</creator><creatorcontrib>Mador, Brett D. ; Panton, O. Neely M. ; Hameed, S. Morad</creatorcontrib><description>Background
The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown that these patients still benefit from cholecystectomy, the optimal timing of this intervention is not well defined. We hypothesized that delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis is associated with significant preventable morbidity.
Methods
A retrospective chart review was performed at two academic hospitals for patients diagnosed with biliary pancreatitis who underwent endoscopic sphincterotomy followed by cholecystectomy. Patients aged 18 and over admitted from 2006 to 2011 were included, while those with severe pancreatitis were excluded. The primary outcome was biliary complications experienced during the waiting period for cholecystectomy. Secondary outcomes included length of stay, operative complications, and conversion rate. Student
t
test was used to compare continuous data and Fischer’s exact test was used for categorical data.
Results
80 patient charts were reviewed. Time to cholecystectomy was 3.3 days (range 0.5–10) in the early group and 141.6 (range 18–757) in the delayed group. The groups were comparable in terms of age and American Society of Anesthesiologists (ASA) classification. 21 of 35 patients (60 %) in the delayed group experienced biliary complications compared with 1 of 45 (2 %) in the early group (
p
< 0.001). 14 patients in the delayed group required re-admission (40 %) and 5 (14 %) required additional procedures. Secondary outcomes were not statistically significant.
Conclusions
The data demonstrate a significantly increased biliary complication rate associated with delayed cholecystectomy in this patient population. Early cholecystectomy should be strongly considered for patients with mild biliary pancreatitis even when endoscopic sphincterotomy has been performed pre-operatively.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-014-3621-8</identifier><identifier>PMID: 24962855</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdominal Surgery ; Acute Disease ; Adult ; Aged ; Cholecystectomy ; Cholecystectomy - methods ; Cholelithiasis - complications ; Cholelithiasis - surgery ; Cysts ; Emergency medical care ; Endoscopy ; Female ; Gallstones ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Length of stay ; Male ; Medical personnel ; Medicine ; Medicine & Public Health ; Middle Aged ; Pancreatitis ; Pancreatitis - etiology ; Pancreatitis - surgery ; Patients ; Proctology ; Retrospective Studies ; Severity of Illness Index ; Sphincterotomy, Endoscopic ; Surgery ; Time Factors ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2014-12, Vol.28 (12), p.3337-3342</ispartof><rights>Springer Science+Business Media New York 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-389c972322b1a43c8741dbcfc425129eb453fdf0f61aae744d4e0059c7251dd23</citedby><cites>FETCH-LOGICAL-c442t-389c972322b1a43c8741dbcfc425129eb453fdf0f61aae744d4e0059c7251dd23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-014-3621-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-014-3621-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24962855$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mador, Brett D.</creatorcontrib><creatorcontrib>Panton, O. Neely M.</creatorcontrib><creatorcontrib>Hameed, S. Morad</creatorcontrib><title>Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown that these patients still benefit from cholecystectomy, the optimal timing of this intervention is not well defined. We hypothesized that delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis is associated with significant preventable morbidity.
Methods
A retrospective chart review was performed at two academic hospitals for patients diagnosed with biliary pancreatitis who underwent endoscopic sphincterotomy followed by cholecystectomy. Patients aged 18 and over admitted from 2006 to 2011 were included, while those with severe pancreatitis were excluded. The primary outcome was biliary complications experienced during the waiting period for cholecystectomy. Secondary outcomes included length of stay, operative complications, and conversion rate. Student
t
test was used to compare continuous data and Fischer’s exact test was used for categorical data.
Results
80 patient charts were reviewed. Time to cholecystectomy was 3.3 days (range 0.5–10) in the early group and 141.6 (range 18–757) in the delayed group. The groups were comparable in terms of age and American Society of Anesthesiologists (ASA) classification. 21 of 35 patients (60 %) in the delayed group experienced biliary complications compared with 1 of 45 (2 %) in the early group (
p
< 0.001). 14 patients in the delayed group required re-admission (40 %) and 5 (14 %) required additional procedures. Secondary outcomes were not statistically significant.
Conclusions
The data demonstrate a significantly increased biliary complication rate associated with delayed cholecystectomy in this patient population. Early cholecystectomy should be strongly considered for patients with mild biliary pancreatitis even when endoscopic sphincterotomy has been performed pre-operatively.</description><subject>Abdominal Surgery</subject><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Cholecystectomy</subject><subject>Cholecystectomy - methods</subject><subject>Cholelithiasis - complications</subject><subject>Cholelithiasis - surgery</subject><subject>Cysts</subject><subject>Emergency medical care</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gallstones</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Length of stay</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Pancreatitis</subject><subject>Pancreatitis - etiology</subject><subject>Pancreatitis - surgery</subject><subject>Patients</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Sphincterotomy, Endoscopic</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUtr3TAQhUVJaW7S_oBuiiCbbtxKI_mhZQhpGwh0066FLI0TBdlyJDvB_7663NsSAl3N4nxz5nEI-cjZF85Y-zUzJhtZMS4r0QCvujdkx6WACoB3J2THlGAVtEqekrOcH1jBFa_fkVOQqoGurndkuDYpbPQJU14zdRjMho7a-xjQbnlBu8Rxo0MMIT776Y7i5GK2cfaW5vneT3bBFI9MoqMPjvY-eJM2OpvJJjSLX3x-T94OJmT8cKzn5Pe3619XP6rbn99vri5vKyslLJXolFUtCICeGyls10ruejtYCTUHhb2sxeAGNjTcGGyldBIZq5Vti-4ciHPy-eA7p_i4Yl706LPFEMyEcc2aN8VcMYCmoBev0Ie4pqlst6cAWCNYWyh-oGyKOScc9Jz8WM7TnOl9CPoQgi4h6H0Iuis9n47Oaz-i-9fx9-sFgAOQizTdYXox-r-ufwBzAZNP</recordid><startdate>20141201</startdate><enddate>20141201</enddate><creator>Mador, Brett D.</creator><creator>Panton, O. Neely M.</creator><creator>Hameed, S. Morad</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20141201</creationdate><title>Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis</title><author>Mador, Brett D. ; Panton, O. Neely M. ; Hameed, S. Morad</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-389c972322b1a43c8741dbcfc425129eb453fdf0f61aae744d4e0059c7251dd23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdominal Surgery</topic><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Cholecystectomy</topic><topic>Cholecystectomy - methods</topic><topic>Cholelithiasis - complications</topic><topic>Cholelithiasis - surgery</topic><topic>Cysts</topic><topic>Emergency medical care</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gallstones</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Length of stay</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Pancreatitis</topic><topic>Pancreatitis - etiology</topic><topic>Pancreatitis - surgery</topic><topic>Patients</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Sphincterotomy, Endoscopic</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mador, Brett D.</creatorcontrib><creatorcontrib>Panton, O. Neely M.</creatorcontrib><creatorcontrib>Hameed, S. Morad</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mador, Brett D.</au><au>Panton, O. Neely M.</au><au>Hameed, S. Morad</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2014-12-01</date><risdate>2014</risdate><volume>28</volume><issue>12</issue><spage>3337</spage><epage>3342</epage><pages>3337-3342</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
The recommended treatment for patients presenting with mild acute biliary pancreatitis is early cholecystectomy performed during the index admission. However, the data are less clear in regards to patients who undergo endoscopic sphincterotomy prior to surgery. While it has been shown that these patients still benefit from cholecystectomy, the optimal timing of this intervention is not well defined. We hypothesized that delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis is associated with significant preventable morbidity.
Methods
A retrospective chart review was performed at two academic hospitals for patients diagnosed with biliary pancreatitis who underwent endoscopic sphincterotomy followed by cholecystectomy. Patients aged 18 and over admitted from 2006 to 2011 were included, while those with severe pancreatitis were excluded. The primary outcome was biliary complications experienced during the waiting period for cholecystectomy. Secondary outcomes included length of stay, operative complications, and conversion rate. Student
t
test was used to compare continuous data and Fischer’s exact test was used for categorical data.
Results
80 patient charts were reviewed. Time to cholecystectomy was 3.3 days (range 0.5–10) in the early group and 141.6 (range 18–757) in the delayed group. The groups were comparable in terms of age and American Society of Anesthesiologists (ASA) classification. 21 of 35 patients (60 %) in the delayed group experienced biliary complications compared with 1 of 45 (2 %) in the early group (
p
< 0.001). 14 patients in the delayed group required re-admission (40 %) and 5 (14 %) required additional procedures. Secondary outcomes were not statistically significant.
Conclusions
The data demonstrate a significantly increased biliary complication rate associated with delayed cholecystectomy in this patient population. Early cholecystectomy should be strongly considered for patients with mild biliary pancreatitis even when endoscopic sphincterotomy has been performed pre-operatively.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24962855</pmid><doi>10.1007/s00464-014-3621-8</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Acute Disease Adult Aged Cholecystectomy Cholecystectomy - methods Cholelithiasis - complications Cholelithiasis - surgery Cysts Emergency medical care Endoscopy Female Gallstones Gastroenterology Gynecology Hepatology Humans Laparoscopy Length of stay Male Medical personnel Medicine Medicine & Public Health Middle Aged Pancreatitis Pancreatitis - etiology Pancreatitis - surgery Patients Proctology Retrospective Studies Severity of Illness Index Sphincterotomy, Endoscopic Surgery Time Factors Treatment Outcome |
| title | Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis |
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