Management of gallstone pancreatitis in Auckland: progress and compliance

Background: Recent advances in the management of acute gallstonepancreatitis include the introduction of laparoscopic cholecystectomy,defining the role of endoscopic retrograde cholangiopancreatography(ERCP) and early cholecystectomy to prevent recurrent pancreatitis.The aim of the present study was to review the current managementof gallstone pancreatitis in Auckland Hospital, compare findingswith a similar study published a decade ago and to determine theextent to which the management is compliant with recently publishedconsensus guidelines. Methods: A retrospective review of consecutive patients admittedwith acute pancreatitis during a 39‐month study period was undertaken.Data were recorded regarding demographics, diagnosis, predictedand actual severity of gallstone pancreatitis (index and recurrentattacks), the role of ERCP and computed tomography scanning, thetiming of cholecystectomy (open and laparoscopic), intraoperativecholangiography, duration of hospital stay, complications and mortality. Results : There were 216 patients admitted with acute pancreatitis,106 of whom had proven gallstones. An ERCP was performed in 62(59%) patients with gallstone pancreatitis but not morecommonly in patients with severe pancreatitis, and common bile duct stoneswere identified in 26% of these patients. Of the 70 (66%)patients who had a cholecystectomy, 56 (80%) had it within3 weeks of admission. Although the proportion of patientswith gallstone pancreatitis who had a cholecystectomy is similarto the earlier study, there has been a significant increase in theproportion of patients having a cholecystectomy during the indexadmission (χ² = 3.83; P = 0.05).This has resulted in a reduction in recurrent pancreatitis (P < 0.001).Although the overall mortality from gallstone pancreatitis has notsignificantly decreased, it has for patients with predicted severegallstone pancreatitis (P = 0.02). Conclusion : There has been reasonable compliance with publishedguidelines and some progress in the management of gallstone pancreatitis,particularly in relation to performing timely laparoscopic cholecystectomywith a reduction in the incidence of recurrent pancreatitis. Concernsremain regarding the overuse of diagnostic ERCP in patients withmild pancreatitis.