OBJECTIVE:
To compare the efficacy of endoscopic retrograde cholangiopancreatography
+/- endoscopic sphincterotomy (ERCP +/- ES) versus traditional conservative
management in early gallstone pancreatitis with persistent ampullary
obstruction (GSP + AO).
SUMMARY BACKGROUND DATA:
The effectiveness of early ERCP +/- ES in this setting is controversial.
METHODS:
Sixty-one consecutive patients with GSP + AO within 48 hours from the onset
of symptoms were randomized to receive either conservative treatment and
selective ERCP +/- ES after 48 hours (control group, 31 patients) or initial
conservative treatment and systematic ERCP +/- ES within 48 hours if
obstruction persisted 24 hours or longer (study group, 30 patients). Patient
outcome was compared in relation to treatment groups and to duration of
obstruction.
RESULTS:
In the control group, 22 patients disobstructed spontaneously within 48
hours; 3 of the remaining 9 patients underwent ERCP +/- ES and none had
impacted stones. In the study group, 16 patients disobstructed spontaneously
and 14 underwent ERCP within 48 hours from the onset of symptoms; impacted
stones were found and extracted by ES in 79% (11 of 14) of these.
PATIENTS:
There were no deaths in either group. Patients in the study group showed a
shorter period of obstruction (P = 0.016) and a lower rate of immediate
complications (P = 0.026) than controls. Patients with obstruction lasting <
or =48 hours regardless of the treatment group had fewer immediate
complications than those whose obstruction persisted longer (P < 0.001).
CONCLUSIONS:
This study shows that in patients with GSP + AO limiting the duration of
obstruction to not longer than 48 hours by ERCP + ES decreased morbidity.
Reference:
Ann Surg. 2006 Jan;243(1):33-40 |