title: Relapses of biliary acute pancreatitis in patients with previous attack of biliary pancreatitis and gallbladder in situ.
abstract: OBJECTIVE
  To evaluate relapse of acute pancreatitis in patients with biliary pancreatitis in whom coexisting diseases or patient refusal have excluded cholecystectomy.
  
  
  METHODS
  Forty-seven patients presenting a first episode of biliary acute pancreatitis underwent urgent endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES).
  
  
  RESULTS
  ERCP with ES was successful in all but one patient (97.8%) who was then cholecystectomised. Complications related to the endoscopic procedure were reported in five patients (10.6%). During the follow-up period (median time 12 months; range 1-84 months), 10 patients (21%) suffered from biliary complications. Three patients (6.4%), all with lithiasis of the gallbladder, had relapses of acute pancreatitis, two of them within 2 months of the previous episode, and one about a year later after ingestion of a rich meal and alcoholic beverages. The first two were cholecystectomised. Two patients died during the follow-up period from unrelated diseases.
  
  
  CONCLUSIONS
  In subjects who are at high risk for anaesthesia, endoscopic procedures may be utilised.
authors.affiliation: Department of Internal Medicine, Sant'Orsola-M. Malpigli Hospital, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Billi
authors.forename: B
authors.initials: B
authors.lastname: Barakat
authors.forename: N
authors.initials: N
authors.lastname: D'Imperio
authors.forename: R
authors.initials: R
authors.lastname: Pezzilli
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D016717:Sphincterotomy, Endoscopic; D016312:Treatment Refusal