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Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study
Pablo Parra-Membrives1, Ana García-Vico2, Darío Martínez-Baena3
1Surgery, Universidad de Sevilla, Spain.
Insights
Patients with biliary pancreatitis not undergoing surgery face high risks of recurrent pancreatitis and biliary events. Individualized conservative treatment is crucial for those with multiple comorbidities and limited life expectancy.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Biliary pancreatitis is a common cause of acute pancreatitis.
- Cholecystectomy is the standard treatment to prevent recurrence.
- Some patients with biliary pancreatitis do not undergo surgery for various reasons.
Purpose of the Study:
- To review the long-term outcomes of patients with biliary pancreatitis who did not undergo cholecystectomy.
- To assess the risk of recurrent pancreatitis, biliary events, and mortality in this patient group.
Main Methods:
- Retrospective analysis of 104 patients with biliary pancreatitis who did not undergo cholecystectomy between January 2015 and December 2017.
- Data collected included epidemiologic factors, Charlson's Comorbidity Index (CCI), recurrent pancreatitis or biliary events, and mortality.
- Follow-up duration ranged from 1 to 70 months.
Main Results:
- The median age of patients was 82 years, with an average CCI of 5.
- 39.4% experienced gallstone-related complications.
- 22.1% had recurrent pancreatitis, and 32.7% developed biliary events.
- 24% of patients died during follow-up, with 5.8% mortality attributed to gallstone complications.
Conclusions:
- Patients declining cholecystectomy are at significant risk for biliary events and recurrent pancreatitis.
- Conservative management and surgical abstention should be carefully considered for patients with multiple comorbidities and poor life expectancy.
Background And Objective:
most acute pancreatitis cases are of biliary origin and cholecystectomy is recommended to prevent recurrence. However, some patients will never be referred for surgery. In this study, the long-term follow-up of this group of patients was reviewed.
Methods:
all new cases of biliary pancreatitis from January 2015 to December 2017 that did not undergo cholecystectomy were analyzed. Epidemiologic data and Charlson's comorbidity index (CCI) were recorded. Recurrent episodes of pancreatitis or biliary events and mortality during the follow-up period were recorded.
Results:
a total of 104 patients were included in the study (30.4 % of all biliary pancreatitis cases) and the median age was 82 years (range, 27-96). Average CCI was 5 (range, 0-18) and the median follow-up period was 37 months (range, 1-70). A total of 41 patients (39.4 %) had gallstone-related complications. Twenty-three patients (22,1 %) had recurrent pancreatitis and 34 (32,7 %) developed biliary events. Twenty-five patients died during follow-up (24 %) but only in 6 (5,8 %) was death due to gallstone-related complications. Non-related mortality was 15.5 % in patients who refused surgery and 25 % in multiple-comorbidity patients.
Conclusion:
patients who did not undergo cholecystectomy were at high risk for biliary events and pancreatitis recurrence. Conservative treatment and surgical abstention should be individualized and reserved for patients with multiple comorbidities with a short life expectancy.
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