Delayed Cholecystectomy May Increase Recurrent Biliary Complications
To avoid recurrent biliary complications, the authors of a new study recommend cholecystectomy (CCY) be performed during a patient’s index hospitalization or soon after discharge. Findings showed that delayed CCY could lead to an increased risk of recurrent biliary events (pancreatitis, cholecystitis, or symptomatic choledocholithiasis).
Mohammed Absar Ullah, MD, a gastroenterology fellow at the University of Rochester in Rochester, New York, and colleagues conducted a retrospective chart review of 234 patients with acute biliary pancreatitis seen at the University of Rochester Medical Center from January 2012 to December 2017.
Dr Ullah discussed the study results May 18 at Digestive Disease Week (DDW) 2019 in San Diego, California.
The researchers evaluated patient data on demographics, diagnosis at the time of hospital admission, laboratory findings, whether anticoagulants were used, and whether CCY was performed. Among the patients, the most common admission diagnoses were gallstone pancreatitis (48.7%) or choledocholelithiasis (31.2%).
Most patients (74.8%) underwent endoscopic retrograde cholangiopancreatography (ERCP). During index hospitalization, 41.0% of patients underwent CCY and 54.3% of patients had CCY deferred to the outpatient setting.
Within 60 days of hospital discharge, 46.7% of the participants who deferred CCY at index hospitalization underwent CCY. The number of recurrent biliary events among the entire cohort was 26, with most being gallstone pancreatitis (57.7%).
Results of a Fisher exact test determined that participants who did not undergo CCY or who underwent CCY 60 days or longer after index hospitalization had a significantly higher number of recurrent biliary events (23 vs 3).
“Cholecystectomy should be performed during the index admission for acute biliary pancreatitis or as soon as possible following discharge from hospital to avoid recurrence of biliary complications,” the researchers concluded. “ERCP did not affect the rate of recurrent biliary events in these patients.”
—Melinda Stevens
Reference:
Ullah MA, Dalapathi V, Aranez JL, et al. Timing of cholecystectomy after acute biliary pancreatitis: you snooze, you lose! Presented at: Digestive Disease Week (DDW) 2019; May 18-21, 2019; San Diego, CA. https://www.gastrojournal.org/article/S0016-5085(19)36796-4/pdf. Accessed May 18, 2019.