The effect of cholecystectomy in acute pancreatitis on attacks of pancreatitis

Introduction and Aim: Acute pancreatitis is seen with increasing frequency all over the world and it is important to both treat and prevent relapse due to the risk of mortality. Current guidelines recommend cholecystectomy (CS) in patients with biliary pancreatitis to prevent recurrence. It has been suggested that a significant portion of patients with idiopathic acute pancreatitis (IAP) result from occult biliary disease and CS may be beneficial. In this study, it was aimed to evaluate the effect of CS in preventing pancreatitis recurrence. Method: Patients over the age of 18 who were followed up and treated with the diagnosis of Acute Pancreatitis in the Gastroenterology Clinic of Bezmialem Vakıf University were retrospectively analyzed and biliary and idiopathic patients were included in the analysis. Patients were divided into biliary and idiopathic groups, and the frequency of attacks was evaluated according to the history of CS. In addition, demographic data of the patients, comorbidities and ERCP status were recorded by questioning. Results: İn the study were included 500 patients (300 patients with ABP, 200 patients with idiopathic). The patients were divided into 3 different groups; those who had their first pancreatitis attack after CS, those who had their gallbladder in situ in the first attack and CS after attack, those who had their gallbladder in situ in the first attack but did not have CS. In the ABP group, the frequency of attacks was higher in those who had their first pancreatitis attack after CS (p = 0.018). In the idiopathic group, there was no significant difference between the groups in terms of attack frequency (p = 0.999). When patients with in situ gallbladder during the first attack were compared according to their CS history, no significant difference was found in the frequency of attacks in both the biliary and idiopathic groups between those with and without CS (p > 0.05). In addition to their CS history, the patients were compared in different groups according to their ERCP status. While ERCP in the ABP group decreased the number of attacks in the CS group after the first pancreatitis attack (p = 0.008), it was not significant in the other two groups. In patients with IAP, it was observed that ERCP did not reduce the number of attacks in any of the groups. Conclusion: In biliary acute pancreatitis, while the recurrence of attacks was high in patients who had their first pancreatitis attack after CS, it was found that CS alone was not beneficial in patients with gallbladder in situ and is decreased the risk with ERCP. It was found that CS and ERCP were not effective in reducing the recurrence of attacks in patients with IAP. Key words: Acute biliary pancreatitis, idiopathic acute pancreatitis, cholecystectomy, endoscopic retrograde cholangiopancreatography, relapse, recurrence