title: Multimodal approach to mild biliary pancreatitis based on a risk stratification of choledocholithiasis.
abstract: OBJECTIVE
  The management of acute mild biliary pancreatitis is multidisciplinary and still presents controversies in the diagnostic and therapeutic strategies. The aim of this retrospective study is to establish if a risk stratification of choledocholithiasis can optimize the employment of technological resources and medical competence in the treatment of individual patients in a tailored way. Our personal experience has then been compared with international literature. The main end-point was to evaluate the incidence of recurrence of acute pancreatitis. Secondary end point was to propose an affordable diagnostic and therapeutic algorithm for this relatively common disease.
  
  
  METHODS
  One hundred and one (101) patients affected by acute mild biliary pancreatitis were admitted in the Department of Patologia Chirurgica of "Ospedale SS. Annunziata" of Chieti from January 2004 to June 2011. Patients were divided in three groups; high (I), medium (II) and low risk (III) of choledocholithiasis (CBDS) according to clinical, laboratory and instrumental criteria. On the base of this division, patients in group I were subjected to ERCP with endoscopic sphinterotomy (ES) and subsequent laparoscopic cholecystectomy (LC). Group II patients underwent to MRCP, if positive for CBDS followed by ES and subsequently LC, if negative for CBDS directly LC. Group III patients underwent directly to LC associated with intra-operative cholangiography in selected cases.
  
  
  RESULTS
  No recurrence of acute pancreatitis was observed in patients who completed the diagnostic and therapeutic procedures.
  
  
  CONCLUSIONS
  We believe that the application of a patient stratification in risk groups for choledocholithiasis can optimize the use of medical and technological resources and helps to address a patient for a specific and more appropriate diagnostic and therapeutic investigation allowing, at the same time, to identify patients who can usefully undergo to a simplified diagnostic and therapeutic approach.
authors.affiliation: Operative Unit of Surgical Pathologies, Department of Surgical Experimental SciencesG. D'Annunzio University, "SS Annunziata" Hospital, Chieti, Italy. lmnapoli@unich.it
authors.forename: L
authors.initials: L
authors.lastname: Napolitano
authors.forename: C
authors.initials: C
authors.lastname: Antonopulos
authors.forename: M
authors.initials: M
authors.lastname: Waku
authors.forename: R
authors.initials: R
authors.lastname: Costantini
authors.forename: V
authors.initials: V
authors.lastname: D'Alessandro
authors.forename: D
authors.initials: D
authors.lastname: Risio
authors.forename: P
authors.initials: P
authors.lastname: Innocenti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000150:complications / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D055815:Young Adult