Common bile duct investigation in patients with mild biliary pancreatitis. when and how? A prospective analysis of 48 patients.
OBJECTIVE
To define how and when patients with mild acute biliary pancreatitis must have their biliary tree investigated.


METHODS
We analyzed 48 patients' files with mild biliary pancreatitis between 1995 and 2004. After clinical treatment, magnetic resonance or endoscopic retrograde cholangiopancreatography and then surgery was performed. Statistical data were analyzed through SPSS version 11.0.


RESULTS
Of the 48 patients, 13 (27%) patients had choledocholithiasis. Five of these (38%) were diagnosed and treated by endoscopic retrograde cholangiopancreatography and 8 (62%) patients had choledocholithiasis at magnetic resonance cholangiopancreatography. These 8 patients underwent endoscopic retrograde cholangiopancreatography which found common bile duct stones in only 4 (50%) of them that were treated successfully with papillotomy. All patients underwent laparoscopic cholecystectomy at the same hospital stay with a low morbidity and no mortality.


CONCLUSIONS
We believe that patients with mild biliary pancreatitis should have their biliary tree investigated just after clinical recovery and as close as possible to the operation because many gallstones pass spontaneously through the papillae. We believe that magnetic resonance cholangiopancreatography can avoid an unnecessary endoscopic retrograde cholangiopancreatography.
do Amaral
Paulo César Galvão
PC
General Surgery Division, Hospital São Rafael, Salvador Bahia, Brasil. pcgamaral@terra.com.br
Filho
Euler Azaro
EA
Ettinger
João Eduardo de Marques Menezes
JE
Cunha
André Gusmão
AG
Cangussú
Heron Crusoé
HC
Lima
Marcus de Almeida Correa
Mde A
Fahel
Edvaldo
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D042883:Choledocholithiasis / Q000150:complications* / Q000175:diagnosis*; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D011446:Prospective Studies; D012720:Severity of Illness Index