Early Endoscopic Sphincterotomy in Severe Acute Biliary Pancreatitis: A 10- year Retrospective Analysis of Recurrence and Management

Aims Acute biliary pancreatitis (ABP) is a severe complication of gallstone disease, with mortality rates reaching up to 30%. Early endoscopic sphincterotomy (ES) is a recognized treatment for acute cholangitis or impacted bile duct stones. However, its role in reducing biliary event recurrence in severe ABP, especially before cholecystectomy, remains uncertain. This study evaluates the impact of ES on recurrence of biliary events and associated outcomes in severe ABP.

Methods This retrospective, single-center study included all patients hospitalized for severe ABP from January 2013 to December 2023 without prior cholecystectomy. Severe ABP was defined by a Balthazar CT severity score of D or E. Recurrence of biliary events was defined as new acute pancreatitis, biliary colic, cholecystitis, or cholangitis before cholecystectomy. Patients were divided into those who underwent ES and those who did not, and outcomes were compared.

Results A total of 185 patients were included (median age: 61 years; 55.1% female), with 140 patients undergoing ES and 45 not receiving the procedure. The recurrence rate of biliary events was 8.6% (12/140) in the ES group and 15.5% (7/45) in the non-ES group (p=0.43). Time to recurrence was longer in the ES group (median 306.5 days; IQR 74.25–1236) compared to the non-ES group (median 153 days; IQR 108.5–213, p=0.07). Recurrence of ABP specifically was significantly lower in the ES group (0% vs. 11%, p=0.0007). The median duration of hospitalization was 9 days (IQR 7–19) in both groups. Mortality rates were slightly lower in the ES group (2.1% vs. 4.4%, p=0.59). Admission to intensive or intermediate care occurred in 85% of ES patients and 88.8% of non-ES patients (p=0.62). ES-related complications were observed in 7.8% of cases, including papillary bleeding (9/11), perforation (1/11), and post-procedural pancreatitis (1/11). Optimal timing for cholecystectomy in severe ABP was identified at 31 days, minimizing biliary recurrence with 95% sensitivity and 39% specificity.

Conclusions In severe ABP, routine ES does not significantly reduce the overall risk of biliary event recurrence before cholecystectomy but may lower the risk of recurrent severe ABP. ES should be reserved for selected patients, particularly those ineligible for early cholecystectomy, while timely surgical management remains critical for preventing recurrence.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025