title: Recurrence of acute gallstone pancreatitis and relationship with cholecystectomy or endoscopic sphincterotomy.
abstract: OBJECTIVE
  To determine the prevalence of recurrence of gallstone pancreatitis, its clinical features, and the presence of prognostic factors of recurrence.
  
  
  METHODS
  From January 1, 2000 to August 31, 2003, 233 patients admitted with acute gallstone pancreatitis (AGP) were prospectively studied. Patients were divided into two groups: recurrent and nonrecurrent group. Clinical, analytical, radiological, prognostic parameters, and severity (Atlanta criteria) were assessed, along with the performance of cholecystectomy or endoscopic sphincterotomy (ES). Clinical features of recurrence were analyzed. Univariate (chi(2), Student's t-test) and multivariate tests were performed. Statistical significance was assumed if p < 0.05.
  
  
  RESULTS
  Two hundred and eighty-six attacks were identified. Forty-two patients (18.2%) recurred, suffering 53 recurrent attacks, which took place within 30 days in 23.3%. Patients who did not undergo surgery after the first attack had 31-fold risk of recurrence (OR = 31.5%, CI = 95%[7.22-137.84], p < 0.001). In patients not operated, recurrence was more frequent if ES was not performed (37.04%vs 0%, p= 0.019). Among patients with surgical risk, none who recurred underwent ES, compared with 27.9% of those who did not recur. Patients in the nonrecurrent group underwent cholecystectomy within the first 30 days or ES more frequently (31.2%vs 7.3%, p= 0.001).
  
  
  CONCLUSIONS
  Recurrence of gallstone pancreatitis is a frequent event. Delay of cholecystectomy implies an increased risk of recurrence. ES could be an acceptable option to prevent recurrence in patients who are not candidates for surgery or who do not desire to undergo cholecystectomy.
authors.affiliation: Department of Gastroenterology, University Clinic Hospital of Valencia, University of Valencia, 46010 Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Hernandez
authors.forename: Isabel
authors.initials: I
authors.lastname: Pascual
authors.forename: Pedro
authors.initials: P
authors.lastname: Almela
authors.forename: Ramon
authors.initials: R
authors.lastname: Añon
authors.forename: Belen
authors.initials: B
authors.lastname: Herreros
authors.forename: Vicente
authors.initials: V
authors.lastname: Sanchiz
authors.forename: Miguel
authors.initials: M
authors.lastname: Minguez
authors.forename: Adolfo
authors.initials: A
authors.lastname: Benages
mesh_terms: D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000601:surgery*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic