Long-term outcome of patients with biliary pancreatitis not undergoing cholecystectomy. A retrospective study

Abstract

Background and objective: most acute pancreatitis cases are of biliary origin and cholecystectomy is recommended to prevent recurrence. However, some patients will nev er be referred for surgery. In this study, the long-term fol low-up of this group of patients was reviewed. Methods: all new cases of biliary pancreatitis from January 2015 to December 2017 that did not undergo cholecystec tomy were analyzed. Epidemiologic data and Charlson’s comorbidity index (CCI) were recorded. Recurrent episodes of pancreatitis or biliary events and mortality during the follow-up period were recorded. Results: a total of 104 patients were included in the study (30.4 % of all biliary pancreatitis cases) and the medi an age was 82 years (range, 27-96). Average CCI was 5 (range, 0-18) and the median follow-up period was 37 months (range, 1-70). A total of 41 patients (39.4 %) had gallstone-related complications. Twenty-three patients (22,1 %) had recurrent pancreatitis and 34 (32,7 %) devel oped biliary events. Twenty-five patients died during follow-up (24 %) but only in 6 (5,8 %) was death due to gallstone-related complications. Non-related mortality was 15.5 % in patients who refused surgery and 25 % in multiple-comorbidity patients. Conclusion: patients who did not undergo cholecystec tomy were at high risk for biliary events and pancreatitis recurrence. Conservative treatment and surgical abstention should be individualized and reserved for patients with mul tiple comorbidities with a short life expectan.