title: Long-term effectiveness of cholecystectomy and endoscopic sphincterotomy in the management of gallstone pancreatitis.
abstract: BACKGROUND
  Gallstone pancreatitis (GSP) is a common condition, accounting for 30-40 % of all pancreatitis cases. All GSP patients should undergo definitive treatment to prevent further attacks. This study aimed to investigate the long-term outcome after definitive treatment in England by cholecystectomy, endoscopic sphincterotomy (ES), or both.
  
  
  METHODS
  Hospital episode statistics data were used to identify patients admitted for the first time with GSP between January and December 2005. These patients were followed for 18 months to identify those who underwent definitive treatment. Treatment groups then were followed until December 2010 to identify readmissions with a further GSP attack as an emergency or admissions with complications of gallstone disease.
  
  
  RESULTS
  5,079 patients admitted with a first bout of GSP between January and December 2005. The in-hospital mortality rate was 7.8 %. Of those who survived the initial attack, 2,511 went on to have a cholecystectomy, 419 had an ES alone, and 496 had ES followed by cholecystectomy. Recurrent pancreatitis after definitive treatment was more common among patients treated with ES (6.7 %) than among those treated with cholecystectomy (4.4 %) or ES followed by cholecystectomy (1.2 %) (p < 0.05). Admissions with other complications attributable to gallstones in patients treated with ES alone were similar to those seen in patients who had received no definitive treatment (12.2 vs. 9.4 %).
  
  
  CONCLUSIONS
  Cholecystectomy offers better protection than ES against further bouts of pancreatitis in patients with GSP, but ES is an acceptable alternative. Interval cholecystectomy in patients treated initially with ES was the most effective method of preventing further pancreatitis, and the patients who underwent treatment by ES alone remained at risk of readmission with gallstone-related problems. Patients who have undergone ES and are fit for surgery should have a cholecystectomy.
authors: Department of Surgery, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, CW1 4QJ, UK, drabdoosh@yahoo.co.uk.
authors: Abdalla
authors: A
authors: Mustafa
authors: Irena
authors: I
authors: Begaj
authors: Mark
authors: M
authors: Deakin
authors: Damien
authors: D
authors: Durkin
authors: David J
authors: DJ
authors: Corless
authors: Richard
authors: R
authors: Wilson
authors: John P
authors: JP
authors: Slavin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
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