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

TRNA, Jan, Santhi Swaroop VEGE, Veronika PŘÍBRAMSKÁ, Suresh T. CHARI, Patrick S. KAMATH, Michael L. KENDRICK and Michael B. FARNELL. 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. Surgery. 2012, vol. 151, No 2, p. 199–205. ISSN 0039-6060. Available from: https://dx.doi.org/10.1016/j.surg.2011.07.017.

Basic information

• Original name: 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
• Authors: TRNA, Jan (203 Czech Republic, guarantor, belonging to the institution), Santhi Swaroop VEGE (840 United States of America), Veronika PŘÍBRAMSKÁ (203 Czech Republic), Suresh T. CHARI (840 United States of America), Patrick S. KAMATH (840 United States of America), Michael L. KENDRICK (840 United States of America) and Michael B. FARNELL (840 United States of America).
• Edition: Surgery, 2012, 0039-6060.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30000 3. Medical and Health Sciences
• Country of publisher: Ireland
• Confidentiality degree: is not subject to a state or trade secret
• Impact factor: Impact factor: 3.373
• RIV identification code: RIV/00216224:14110/12:00062712
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.surg.2011.07.017
• UT WoS: 000299607800008
• Keywords in English: enzyme; liver; gallstones

Abstract

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.