From the Research
Gallstone pancreatitis accounts for approximately 50% of cases of acute pancreatitis, as reported in the most recent study 1. The condition develops when gallstones migrate from the gallbladder and temporarily obstruct the pancreatic duct or the common bile duct near the ampulla of Vater, triggering inflammation of the pancreas. Some key points to consider in the management of gallstone pancreatitis include:
- The importance of goal-directed, moderate fluid resuscitation to decrease the risk of fluid overload and mortality 1
- The need for same-admission cholecystectomy in patients with isolated, mild gallstone pancreatitis, with early cholecystectomy within 48 hours of admission supported by several randomized clinical trials 1
- The role of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with suspected cholangitis or biliary obstruction, although this is rare in patients with gallstone pancreatitis 1
- The use of intraoperative cholangiography to evaluate the common bile duct and rule out concomitant choledocholithiasis, which may be associated with reduced length of stay and decreased use of ERCP 1
The incidence of gallstone pancreatitis increases with age, particularly after 40 years, and varies by ethnicity, with higher rates in Hispanic and Native American populations. Some of the key risk factors for developing gallstone pancreatitis include:
- Female gender
- Obesity
- Rapid weight loss
- Pregnancy
- Certain medications, such as estrogen therapy Once a person has experienced an episode of gallstone pancreatitis, the risk of recurrence is approximately 30-50% within 6 weeks if the gallbladder is not removed 2. Therefore, cholecystectomy (surgical removal of the gallbladder) is typically recommended within the same hospitalization or within 2-4 weeks after resolution of the initial attack to prevent recurrence.
In terms of the management of gallstone pancreatitis, it is essential to consider the severity of the disease and the presence of any concomitant biliary diagnoses. Some of the key considerations include:
- The use of antibiotics in patients with suspected or confirmed infected pancreatic necrosis and extrapancreatic infections 3
- The importance of monitoring for local and systemic complications, such as organ failure and sepsis 3
- The role of contrast-enhanced computed tomography in evaluating the severity of acute pancreatitis and predicting the likelihood of complications 4