title: ERCP and endoscopic sphincterotomy (ES): a safe and definitive management of gallstone pancreatitis with the gallbladder left in situ.
abstract: OBJECTIVE
  UK guidelines recommend that patients with gallstone pancreatitis have cholecystectomy within 2 weeks of their pancreatitis. A proportion of these are elderly with significant comorbidities rendering them high risk for general anaesthesia and surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) may offer a safe alternative to cholecystectomy as definitive treatment in these patients.
  
  
  METHODS
  A retrospective review of all cases of gallstone pancreatitis presenting between 1999 and 2009 was undertaken.
  
  
  RESULTS
  One hundred one patients underwent ERCP and ES as a definitive treatment for gallstone pancreatitis with a median age of 78 years (range, 43-96 years) and a median American Society of Anesthesiologists grade of 2. Three patients died from pancreatitis despite successful ERCP. Eighty-nine patients were successfully treated with an ERCP alone, and 84 patients (94%) had no recurrence of pancreatitis with a mean follow-up of 41 months (±32 months, range 4-118 months). The total patient follow-up was 3,260 months. Twenty-seven patients (33%) died within the follow-up period of unrelated causes, explaining the lower than expected median follow-up. Five patients had a recurrence of pancreatitis during follow-up (6%).
  
  
  CONCLUSIONS
  ERCP with ES is a safe alternative to laparoscopic cholecystectomy to prevent further attacks of gallstone pancreatitis in high-risk surgical patients and the elderly.
authors: Department of General Surgery, Norfolk and Norwich Hospital, Norwich, UK.
authors: Mark
authors: M
authors: Bignell
authors: Matthew
authors: M
authors: Dearing
authors: Andrew
authors: A
authors: Hindmarsh
authors: Michael
authors: M
authors: Rhodes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D004739:England; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000601:surgery*; D042882:Gallstones / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome