Back to 2025 Abstracts

---

THE TIMING DILEMMA: EARLY VS. INTERVAL CHOLECYSTECTOMY IN PATIENTS WITH MODERATELY-SEVERE BILIARY ACUTE PANCREATITIS
Donghyun Ko^*2, Do Han Kim³, Pedro J. Palacios⁴, Wilhelm S. Basegoda⁵, Jose A. Porres⁶, Klaus E. Monkemuller⁷, Paul T. Kröner^1
1Gastroenterology / Interventional Endoscopy, Riverside Health System, Newport News, VA; ²Bridgeport Hospital, Bridgeport, CT; ³Mount Sinai Health System, New York, NY; ⁴Jefferson Health, Wayne, PA; ⁵University of South Alabama, Mobile, AL; ⁶Universidad Francisco Marroquin, Guatemala City, Guatemala, Guatemala; ⁷Virginia Polytechnic Institute and State University, Blacksburg, VA

Introduction
Same-admission cholecystectomy (CCY) has been proposed to reduce the rate of recurrent gallstone-related complications in patients with mild biliary acute pancreatitis (BAP) with low-risk of CCY-related complications, as compared to interval CCY. However, studies suggest that the approach should be more cautiously individualized in patients with moderate-severe BAP, as same admission CCY may be associated with higher morbidity and mortality. The aim of this study was to explore the outcomes of patients with BAP undergoing same-admission CCY, as compared to patients with BAP and interval cholecystectomy using a large multinational database.

Methods
A retrospective cohort study was performed using large population-based data from the TriNetX platform. Patients with BAP who underwent CCY within 14 days since January 1, 2014, were identified. Patients with mild AP were excluded. This group was matched with patients diagnosed of BAP who underwent CCY 14 days after BAP according to age, gender, demographics, comorbidities, and medication by using 1:1 propensity matching. Cox regression was used to yield hazard ratios (HR) and 95% confidence intervals (95%CI). The primary outcome was all-cause mortality. Secondary outcomes were shock, mechanical ventilation, ICU admission, acute kidney injury (AKI), venous thromboembolism (VTE), pancreatic pseudocyst, AP with necrosis, ERCP, acute cholangitis, rehospitalization, recurrent BAP, acute cholecystitis, and choledocholithiasis.

Results
A total of 3,557 adult patients with BAP who underwent CCY were identified, out of which 2,802 underwent CCY within 14 days of diagnosis of BAP. Of these, 708 were matched to patients who underwent CCY 14 days after diagnosis of BAP. Patients who underwent earlier CCY had significantly higher risk of rehospitalization (HR, 1.31; 95%CI, 1.12-1.52). In addition, patients undergoing early CCY had higher occurrence of BAP (HR, 1.88; 95% CI, 1.42-2.50), and undergoing ERCP (HR, 1.50; 95% CI, 1.06-2.12). No significant differences were observed in all-cause mortality, shock, mechanical ventilation, and ICU admission (Table 1).

Discussion
Early cholecystectomy (<14 days) in moderate-to-severe biliary acute pancreatitis (BAP) is associated with higher rates of rehospitalization, ERCP use and recurrent BAP, likely reflecting baseline patient complexity, incomplete biliary clearance on early ERCP, or closer monitoring in this group. While seemingly paradoxical, recurrent BAP may also potentially result from residual pathology or unresolved inflammation before surgery. Despite these associations, early CCY showed no increase in mortality or major complications compared to delayed CCY. These findings highlight the need for careful patient selection and further studies to optimize CCY timing in BAP management.

---

Back to 2025 Abstracts