Abstracts
2001 Digestive Disease Week

# 2464 Biliary Pancreatitis in Cholecystectomized Patients: Not an Unusual Finding
Beat Gloor, Christophe A. Mueller, Mathias Worni, Waldemar Uhl, Markus W Buechler, Bern, Switzerland

Background: Gallstones are a well known cause of acute pancreatitis (AP). There is a lack of data about the frequency of biliary AP in the postcholecystectomy patient. The aim of this study was to identify the patient at risk for biliary pancreatitis after cholecystectomy and to describe the management in these patients.

Methods: Between 1/94 and 8/2000 data of 263 consecutive patients with AP were prospectively entered into a database and reviewed for this study. A biliary etiology in a postcholecystectomy patient was assumed in the absence of any known risk factor for AP combined with the typical picture of biliary pancreatitis diagnosed by transcutaneous ultrasonography and/or laboratory findings of cholestasis (elevated serum aspartate aminotransferase (ASAT), alkaline phosphatase and/or bilirubin). Endoscopic retrograde cholagio-pancreatography (ERCP) was used as the gold standard to diagnose choledochal sludge or bile duct stones.

Results: Overall, a biliary etiology was found in 119 (45%) patients. Of those 11% (13/119) had undergone open or laparoscopic cholecystectomy (CCE) prior to the current episode of AP. There were 7 women and 6 men with a mean age of 55years. ERCP was performed in all 13 patients and papillotomy and stone or sludge removal was successful in 12. In the remaining patient ERCP findings suggested a state after stone passage. A dilated choledochus (>1.5cm) was found in 3 patients and a duodenal diverticulum in one. In two patients the time interval between CCE and AP was as short as 1 month and bile duct stones overlooked at the time of CCE most likely were responsible for the recurrent biliary AP. In the remaining 11 patients CCE was done in mean 7 years (range 1 to 25years) previously. No surgical bile duct exploration was necessary. Of 13 patients with a postcholecystectomy biliary pancreatitis 7 suffered from mild AP and 6 from severe necrotizing disease, respectively. Mortality was 7.5% (1/13) due to infected pancreatic necrosis and septic multi-organ dysfunction. During a mean follow-up of 41 months none of the surviving 12 patients was readmitted because of biliary symptoms.

Conclusions: 11% of all cases of biliary pancreatitis occur in patients without gallbladder. 46% of those had a severe course of the disease. ERCP, papillotomy and stone or sludge extraction are the treatment of choice. Surgical bile duct exploration is hardly ever necessary.