Optimal timing of cholecystectomy after necrotising biliary pancreatitis crucial: Study

There is limited evidence regarding the optimal timing and safety of cholecystectomy in patients with necrotising biliary pancreatitis. The optimal timing of cholecystectomy after necrotising biliary pancreatitis, in the absence of peripancreatic collections, is within 8 weeks after discharge, suggests a study conducted by Nora D Hallensleben and colleagues from the Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.

The study is published in The Gut Journal.

A post hoc analysis of a multicentre prospective cohort was carried out. Patients with biliary pancreatitis and a CT severity score of three or more were included in the trial.

Primary outcome was the optimal timing of cholecystectomy in patients with necrotising biliary pancreatitis which was defined as the optimal point in time with the lowest risk of recurrent biliary events and the lowest risk of complications of cholecystectomy.

While, the 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.

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.

The following findings were established –

1. Infected necrosis after cholecystectomy occurred in four (2%) patients with persistent peripancreatic collections.
2. Before cholecystectomy, 66 patients (27%) developed biliary events.
3. 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).
4. 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).
5. The complication rate of cholecystectomy did not decrease over time.
6. Endoscopic sphincterotomy did not reduce the risk of recurrent biliary events.

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

http://dx.doi.org/10.1136/gutjnl-2021-324239