Role of cholecystectomy in preventing recurrent cholangitis

Whether cholecystectomy should be performed after an episode of acute cholangitis is still unresolved. The purpose of this study was to analyze the role of elective cholecystectomy in preventing recurrent acute cholangitis in Asian patients.

Two hundred ten consecutive Asian patients with acute cholangitis caused by choledocholithiasis with coexisting cholelithiasis were studied prospectively.

Forty-one patients (19.5%, Group 1) agreed to elective cholecystectomy whereas 169 patients (80.5%, Group 2) did not. Mean (+/- SEM) follow-up for Groups 1 and 2 were, respectively, 110.2 +/- 6.6 and 96.8 +/- 2.9 months. Endoscopic papillotomy was performed in 120 patients, 22 (53.7%) in Group 1 and 98 (58%) in Group 2. Recurrent acute cholangitis developed in 31 patients (14.8%), 9 in Group 1 and 22 in Group 2. There was no significant difference in the Kaplan-Meier estimates of the cumulative probability of occurrence of recurrent acute cholangitis between the 2 groups (p = 0.90). Recurrent acute cholangitis developed in 10 patients (8.3%) who underwent endoscopic papillotomy and in 21 (23.3%) patients who did not. There was a significant difference in the Kaplan-Meier estimates of the cumulative probability of occurrence of recurrent acute cholangitis between the patients with endoscopic papillotomy versus those without endoscopic papillotomy (p = 0.001).

Cholecystectomy did not prevent recurrent acute cholangitis in Asian patients. In these patients, early endoscopic papillotomy lowered the frequency of recurrent acute cholangitis.