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Lack of significant liver enzyme elevation and gallstones and/or sludge on ultrasound on day 1 of acute pancreatitis is associated with recurrence after cholecystectomy: a population-based study.

AbstractBACKGROUND:
In a population-based study, we examined recurrence rates of acute pancreatitis (AP) after cholecystectomy performed to prevent recurrences of AP.
METHODS:
We abstracted data from medical records of all Olmsted county residents who underwent cholecystectomy at Mayo Clinic for the management of presumed gallstone or idiopathic AP between 1990 and 2005 (n = 239). Based on (i) significantly elevated liver enzymes (≥threefold increase of alanine aminotransferase or aspartate aminotransferase) on day 1 and (ii) the presence of gallstones/sludge in the gall bladder, we categorized patients into 4 groups: A (i + ii), B (i but not ii), C (ii but not i), and D (neither i nor ii). Recurrence rates of AP after cholecystectomy were determined in all groups.
RESULTS:
The median follow-up after cholecystectomy was 99 months (range, 8-220). AP recurred in 13 of 142 patients (9%) in group A, 1 of 17 patients (6%) in group B, 13 of 57 patients (23%) in group C, and 14 of 23 patients (61%) in group D (P < .0001 D vs. all other groups and P = .001 C vs. groups A and B). No difference was seen in recurrence rates in groups A vs. B (P = 1.0). Recurrences were more frequent in patients with normal liver enzymes (A + B vs. C + D; P = .000003) and in patients without sonographic evidence of gallstones/sludge (A + C vs. B + D; P = .0008).
CONCLUSION:
When AP is associated with significantly elevated liver enzymes on day 1, recurrence rates after cholecystectomy are low (9%). However, postcholecystectomy recurrence rates of AP are high in those without such laboratory abnormalities (34%), especially in those without gall bladder stones/sludge (61%) on abdominal ultrasonography. Our results raise doubts about the efficacy of cholecystectomy to prevent recurrent AP in patients with the absence of either a significant elevation of liver tests on day 1 of AP or gallstones and/or sludge in the gall bladder on initial ultrasound examination.
AuthorsJan Trna, Santhi Swaroop Vege, Veronika Pribramska, Suresh T Chari, Patrick S Kamath, Michael L Kendrick, Michael B Farnell
JournalSurgery (Surgery) Vol. 151 Issue 2 Pg. 199-205 (Feb 2012) ISSN: 1532-7361 [Electronic] United States
PMID21975288 (Publication Type: Journal Article)
CopyrightCopyright © 2012 Mosby, Inc. All rights reserved.
Chemical References
  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase
Topics
  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine Transaminase (metabolism)
  • Aspartate Aminotransferases (metabolism)
  • Bile (diagnostic imaging)
  • Biomarkers (metabolism)
  • Cholecystectomy
  • Female
  • Follow-Up Studies
  • Gallstones (diagnostic imaging, surgery)
  • Humans
  • Incidence
  • Liver (enzymology)
  • Male
  • Middle Aged
  • Pancreatitis (epidemiology, prevention & control)
  • Predictive Value of Tests
  • Retrospective Studies
  • Secondary Prevention
  • Sensitivity and Specificity
  • Treatment Outcome
  • Ultrasonography
  • Young Adult

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