Biliary pancreatitis – is endoscopic sphincterotomy an alternative approach for patients unfit for cholecystectomy?

Aims Although cholecystectomy is recommended in patients with acute biliary pancreatitis to avoid a recurrence of pancreatitis and other biliary events, some patients, given their age and comorbidities, are unfit for surgery.

Aims: To asses if endoscopic sphicterotomy (ES) reduces the risk of recurrent biliary pancreatitis (RBP) ou gallstone-related events in patients unfit for cholecystectomy.

Methods Retrospective review of all patients older than 65 years admitted for a first episode of acute biliary pancreatitis unfit for cholecystectomy between January 2016 to June 2019.

Results 58 patients included, average age 80.93 ± 7.79 years, 53% female. Average Charlson Comorbity Index (CCI) was 4,76 ± 1,56. In most cases (94.83%), the severity of pancreatitis was mild or moderately severe; 4 patients died.

24 patients had ERCP with ES only, while 34 had no intervention during initial hospitalization.

The risk of recurrent pancreatitis was 12,07%. All these patients had no intervention during initial hospitalization. The medium time to recurrence was 6.29 ± 7.09months. Patients who had ES had proportionally less incidence of RGP with statistical significance (p=0,018).

CCI (p=0,03) was independently associated with recurrence, while age and sex were not.

There was no statistical significance association between ES and other biliary events.

Conclusions Our results suggest that ERCP with ES may be an acceptable approach in elderly patients who more commonly have comorbidities associated with high surgical-anesthesiology risk. Future studies are needed to accurately identify these patients.

Publication History

Article published online:
14 April 2023