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Original research
Optimal timing of cholecystectomy after necrotising biliary pancreatitis
  1. Nora D Hallensleben1,2,
  2. Hester C Timmerhuis2,3,
  3. Robbert A Hollemans4,5,
  4. Sabrina Pocornie2,
  5. Janneke van Grinsven6,
  6. Sandra van Brunschot4,
  7. Olaf J Bakker3,
  8. Rogier van der Sluijs7,
  9. Matthijs P Schwartz8,
  10. Peter van Duijvendijk9,
  11. Tessa Römkens10,
  12. Martijn W J Stommel11,
  13. Robert C Verdonk12,
  14. Marc G Besselink6,
  15. Stefan A W Bouwense13,
  16. Thomas L Bollen14,
  17. Hjalmar C van Santvoort3,4,
  18. Marco J Bruno15
  19. for the Dutch Pancreatitis Study Group
  1. 1Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands
  2. 2Department of Research and Development, Sint Antonius Hospital, Nieuwegein, The Netherlands
  3. 3Department of Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
  4. 4Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
  5. 5Department of Surgery, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
  6. 6Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centres, Amsterdam, The Netherlands
  7. 7Department of Radiology, Center for Artificial Intelligence in Medicine and Imaging Stanford University, Stanford, California, USA
  8. 8Department of Internal Medicine and Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
  9. 9Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
  10. 10Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
  11. 11Surgery, Radboudumc, Nijmegen, The Netherlands
  12. 12Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
  13. 13Department of Surgery, Maastricht UMC+, Maastricht, The Netherlands
  14. 14Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
  15. 15Gastroenterology and Hepatology, Erasmus Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Nora D Hallensleben, Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands; n.hallensleben{at}antoniusziekenhuis.nl

Abstract

Objective Following an episode of acute biliary pancreatitis, cholecystectomy is advised to prevent recurrent biliary events. There is limited evidence regarding the optimal timing and safety of cholecystectomy in patients with necrotising biliary pancreatitis.

Design A post hoc analysis of a multicentre prospective cohort. Patients with biliary pancreatitis and a CT severity score of three or more were included in 27 Dutch hospitals between 2005 and 2014. Primary outcome was the optimal timing of cholecystectomy in patients with necrotising biliary pancreatitis, defined as: the optimal point in time with the lowest risk of recurrent biliary events and the lowest risk of complications of cholecystectomy. Secondary outcomes were the number of recurrent biliary events, periprocedural complications of cholecystectomy and the protective value of endoscopic sphincterotomy for the recurrence of biliary events.

Results Overall, 248 patients were included in the analysis. Cholecystectomy was performed in 191 patients (77%) at a median of 103 days (P25–P75: 46–222) after discharge. Infected necrosis after cholecystectomy occurred in four (2%) patients with persistent peripancreatic collections. Before cholecystectomy, 66 patients (27%) developed biliary events. The risk of overall recurrent biliary events prior to cholecystectomy was significantly lower before 10 weeks after discharge (risk ratio 0.49 (95% CI 0.27 to 0.90); p=0.02). The risk of recurrent pancreatitis before cholecystectomy was significantly lower before 8 weeks after discharge (risk ratio 0.14 (95% CI 0.02 to 1.0); p=0.02). The complication rate of cholecystectomy did not decrease over time. Endoscopic sphincterotomy did not reduce the risk of recurrent biliary events (OR 1.40 (95% CI 0.74 to 2.83)).

Conclusion The optimal timing of cholecystectomy after necrotising biliary pancreatitis, in the absence of peripancreatic collections, is within 8 weeks after discharge.

  • cholecystectomy
  • acute pancreatitis

Data availability statement

Data are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request from the corresponding author.

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Footnotes

  • NDH and HCT are joint first authors.

  • HCvS and MJB are joint last authors.

  • Contributors NDH, HCT, RAH, SAWB, HvS and MB contributed to conception and design. SP, JvG, SvB, OJB, MPS, PvD, TR, MJWS, RCV, MGB contributed to acquisition of data. TLB contributed to assessment of imaging. NDH, HCT, RvdS contributed to statistical analysis and interpretation of data. NDH and HCT contributed to drafting manuscript. NDH, HCT, RAH, SP, JvG, SvB, OJB, MPS, PvD, TR, TLB, SAWB, MJWS, RCV, MGB, HCvS and MJB contributed to critical appraisal of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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