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Prevalence of Persistent Common Bile Duct Stones in Acute Biliary Pancreatitis Remains Stable Within the First Week of Symptoms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Acute biliary pancreatitis (ABP) is often associated with persistent common bile duct (CBD) stones. The best strategy in terms of timing of surgery is still controversial. The aim of the current study is to describe the prevalence of persistent common bile duct (CBD) stones in ABP during the first week of symptoms at a high-volume referral center.

Study Design

Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of ABP who underwent laparoscopic cholecystectomy (LC) between January 2009 and December 2019 were extracted.

Results

Two hundred thirty-one patients were included. Cholecystectomy was performed laparoscopically in 230 (99.57%) patients. Intraoperative cholangiogram was performed in all patients. Two hundred nine (90%) patients had surgery within the first 7 days. Global prevalence of persistent CBD stones during IOC was 19.91% (95% CI 14.96–25.65). No significant association between timing to surgery and presence of CBD stones was found for the first week since the initial attack (p=0.28). Prevalence of CBD stones was significantly higher after day 7 (p=0.007 and 0.005). Positive findings in preoperative MRCP are significantly related to intraoperative CBD stones (p=0.0001). Mild postoperative complications (CD I/II) were present in 21 patients (9.09%). No difference was found in morbidity between CBD stones group and non-CBD stones group (p=0.48). We observed no severe complications nor mortality.

Conclusions

In patients with mild acute biliary pancreatitis, the prevalence of persistent CBD stones does not change within the first 7 days since the onset of symptoms. This fact may have major clinical relevance when deciding the optimal therapeutic strategy in this population.

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Authors and Affiliations

  1. HPB Surgery Section, Department of General Surgery, Hospital Italiano de Buenos Aires, Tte. Gral. Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina

    Maria Eugenia Fratantoni, Pablo Giuffrida, Juliana Di Menno, Rodrigo Sanchez Clariá, Martin Palavecino & Oscar Mazza

  2. HPB Surgery Section and Liver Transplant Unit, General Surgery Service, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina

    Victoria Ardiles, Martín de Santibañes, Eduardo de Santibañes & Juan Pekolj

Authors
  1. Maria Eugenia Fratantoni
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  2. Pablo Giuffrida
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Contributions

Study conception and design: Fratantoni ME, de Santibañes M, and Mazza O

Acquisition of data: Fratantoni ME, Giuffrida P, and Di Menno J

Analysis and interpretation of data: Fratantoni ME, Giuffrida P, Di Menno J, Ardiles V, de Santibañes M, Sanchez Claria R, Palavecino M, de Santibañes E, Pekolj J, and Mazza O

Drafting of manuscript: Fratantoni ME, Giuffrida P, Di Menno J, Ardiles V, de Santibañes M, Sanchez Claria R, Palavecino M, de Santibañes E, Pekolj J, and Mazza O

Critical revision: Fratantoni ME, Giuffrida P, Di Menno J, Ardiles V, de Santibañes M, Sanchez Claria R, Palavecino M, de Santibañes E, Pekolj J, and Mazza O

Corresponding author

Correspondence to Maria Eugenia Fratantoni.

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Ethical Considerations

The study was carried out in full agreement with current National and International regulations: Declaration of Helsinki of the World Medical Association and the Standards of Good Clinical Practices ICH E6. The protocol was approved by the Institutional Review Board (IRB) with number 5381, and all study data was treated with maximum confidentiality anonymously and with restricted access only for authorized personnel for the purposes of the study.

Research Involving Human Participants and/or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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For this type of study, formal consent is not required.

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The authors declare no competing interests.

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Fratantoni, M.E., Giuffrida, P., Di Menno, J. et al. Prevalence of Persistent Common Bile Duct Stones in Acute Biliary Pancreatitis Remains Stable Within the First Week of Symptoms. J Gastrointest Surg 25, 3178–3187 (2021). https://doi.org/10.1007/s11605-021-05068-0

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