Recurrence rates in patients with first episodes of acute pancreatitis

Introduction

The timing of operative intervention in patients with suspected biliary pancreatitis is debated. Recurrence rates of pancreatitis in patients with biliary lithiasis are compared in operated and nonoperated patients. Recurrences in patients with suspected nonbiliary pancreatitis are also reported.

Methods

First episodes of acute pancreatitis were identified in consecutive emergency department patients over a 2-year period. Data were evaluated retrospectively and then the identified patients were then followed prospectively for 2 years more.

Results

Pancreatitis was defined clinically as constant epigastric pain associated with elevation of the serum lipase to greater than three times the upper reference value (177 U/l) and no other identified cause of abdominal pain. Of 356 patients with first episodes of acute pancreatitis, 259 had pancreatitis that was ultimately associated with biliary lithiasis based on abdominal ultrasound (n = 236), positive endoscopic retrograde pancreotography (n = 11), surgical pathology report (n = 11), or cholecystostomy (n = 1). Ninety-seven patients had no identified stones during the study period. Cholecystectomy was performed in 235/259 at the time of admission for pancreatitis. Reasons for nonoperative management were death (three cases), medical contraindications (15 cases), pregnancy (two cases) and delayed diagnosis due to negative abdominal sonogram (four cases). During the study period 10% (10/97) of patients without demonstrated stones returned with recurrent episodes of pancreatitis. There were two recurrences in 235 operated patients with stones (0.85%). Twelve of 19 nonoperated survivors with biliary lithiasis returned with complications of biliary lithiasis, including 10 recurrences of biliary pancreatitis (53%) and two episodes of common bile duct obstruction, one of which resulted in death from cholangitis. The median time to recurrence of pancreatitis in nonoperated patients with stones was 50 days, range 26–581 days.

Conclusion

Cholecystectomy reduced the incidence of recurrence of pancreatitis in patients with biliary lithiasis.