Acute biliary pancreatitis: a prospective observational hospital-based study

Harsha B. Kodliwadmath; B. Srinivas Pai; Manasa Ubarale

doi:10.18203/2349-2902.isj20202530

Authors

Harsha B. Kodliwadmath Department of General Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
B. Srinivas Pai Department of General Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India
Manasa Ubarale Department of General Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20202530

Keywords:

Pancreatitis, Biliary pancreatitis, ERCP, Early cholecystectomy, CT severity index

Abstract

Background: Acute biliary pancreatitis (ABP) is one of the most serious complications of gall stone disease with a high risk of morbidity and mortality. Hence accurate diagnosis and prompt management of ABP is very crucial. Different management strategies exist regarding indications and timing for interventions, endoscopic retrograde cholangio-pancreaticography (ERCP) and cholecystectomy.

Methods: Ours is a prospective observational study of the different clinical presentations and management strategies and their respective outcomes in our hospital. All cases of ABP admitted over a period of one year were included in the study. The clinical presentation, severity and course of the disease, imaging studies, duration of ICU and hospital stay and timing of ERCP and cholecystectomy were studied.

Results: A total of 56 cases were included in the study. Average age was 45 years. Pain abdomen was the most common symptom at presentation. About 82% patients had mild to moderate disease while the rest had severe disease. The mean duration of intensive care unit stay was 8 days. ERCP was done in 6 cases. Cholecystectomy during the same admission was dine in 20 cases. There were 2 deaths during the course of the study.

Conclusions: Early intervention definitely reduces morbidity, mortality and recurrent admissions in cases of acute biliary pancreatitis. Same admission laparoscopic cholecystectomy is preferable in mild ABP. All cases of severe ABP must undergo early ERCP irrespective of biliary obstruction. This also helps in reducing readmissions due to pancreatic-biliary complications and is cost-effective.

Metrics

Metrics Loading ...

Author Biography

Harsha B. Kodliwadmath, Department of General Surgery, SDM College of Medical Sciences and Hospital, Sattur, Dharwad, Karnataka, India

ASSOCIATE PROFESSOR, GENERAL SURGERY

References

Negi N. Clinical Profile and Outcome of Acute Pancreatitis: A Hospital Based Prospective Observational Study in Subhimalayan State. J Association Physicians India. 2018;66(1):22-4.

Lyu YX, Cheng YX, Jin HF, Jin X, Cheng B, Lu D. Same admission versus delayed cholecystectomy for mild acute biliary pancreatitis: a systematic review and meta-analysis. BMC Surg. 2018;18:111.

Kim SB, Kim TN, Chung HH, Kim KH. Small Gallstone Size and Delayed Cholecystectomy Increase the Risk of Recurrent Pancreatobiliary Complications After Resolved Acute Biliary Pancreatitis. Dig Dis Sci. 2017;62:777-83.

Anandi HWS, Besselink MGH, Boerma D, Timmer R, Wiezer MJ, van Erpecum KJ, et al. Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones. Surg Endosc. 2008;22:2046-50.

Kumar K, Bondalapati SS. A Retrospective, Comparative Study of Characteristics of Hyper triglyceridemic Pancreatitis and Biliary Pancreatitis in A Tertiary Care Hospital. JDMS. 2019;18(5):47-50.

Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB, et al. A Systematic Review. Annals Surg. 2012;255(5):860-6.

Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. NEJM. 1992;326:589-93.

Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, van Brunschot S, et al. Same admission versus interval cholecystectomy for mild gallstone pancreatitis (PONCHO): a multicentre randomised controlled trial. Lancet. 2015;386(10000):1261-8.

Costa DW, Dijksman LM, Bouwense SA, Schepers NJ, Besselink MG, van Santvoort HC, et al. Cost-effectiveness of same admission versus interval cholecystectomy after mild gallstone pancreatitis in the PONCHO trial. BJS. 2016;103(12):1695-703.

Sand J, Nordback I. Acute pancreatitis: risk of recurrence and late consequences of the disease. Nat Rev Gastroenterol Hepatol. 2009;6:470-7.

Fogel EL, Sherman S. Acute Biliary Pancreatitis: When Should the Endoscopist Intervene. Gastroenterology. 2003;125:229-35.

Fan ST, Lai E, Mok F, Lo CM, Zheng SS, Wong J. Early treatment of biliary pancreatitis by endoscopic papillotomy. NEJM. 1993;328:229-32.

Fölsch UR, Nitsche R, Lüdtke R, Hilgers RA, Creutzfeldt W. Early ERCP and Papillotomy Compared With Conservative Treatment For Acute Biliary Pancreatitis. NEJM. 1997;336:237-42.

Jee SL, Jarmin R, Lim KF, Raman K. Outcomes of early versus delayed cholecystectomy in patients with mild to moderate acute biliary pancreatitis. A randomised prospective study. Asian J Surg. 2018;41:47-54.