Document Detail


Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial.
MedLine Citation:
PMID:  17197959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To test the hypothesis that early endoscopic intervention, performed on patients with acute gallstone pancreatitis and biliopancreatic obstruction, reduces systemic and local inflammation.
SUMMARY BACKGROUND DATA: The role of early endoscopic intervention, in the treatment of acute gallstone pancreatitis, remains controversial. Previous randomized trials have not focused on the subgroup of patients with clinical evidence of biliopancreatic obstruction.
METHODS: This single-center randomized clinical trial was performed between May 2000 and September 2005. Of 238 patients, admitted within 48 hours after the onset of acute gallstone pancreatitis, 103 with a distal bile duct measuring > or =8 mm combined with a total serum bilirubin > or =1.20 mg/dL, were randomized to receive either endoscopic retrograde cholangiopancreatography followed by endoscopic papillotomy for bile duct stones (EEI, n = 51) or early conservative management (ECM, n = 52). Patients with clinical evidence of coexisting acute cholangitis were excluded. Outcome measures included changes in organ failure score and computed tomography (CT) severity index during the first week after admission, incidence of local complications, and overall morbidity and mortality.
RESULTS: The incidence of bile duct stones at EEI was 72% and 40% of patients in the ECM group had persisting bile duct stones at elective biliary surgery. No significant differences were found between the EEI and ECM groups regarding changes in mean organ failure score (P = 0.87), mean CT severity index (P = 0.88), incidence of local complications (6% vs. 6%, P = 0.99), overall morbidity (21% vs. 18%, P = 0.80), and mortality (6% vs. 2%, P = 1).
CONCLUSIONS: The present study failed to provide evidence that early endoscopic intervention reduces systemic and local inflammation in patients with acute gallstone pancreatitis and biliopancreatic obstruction. If acute cholangitis can be safely excluded, early endoscopic intervention is not mandatory and should not be considered a standard indication.
Authors:
Alejandro Oría; Daniel Cimmino; Carlos Ocampo; Walter Silva; Gustavo Kohan; Hugo Zandalazini; Carlos Szelagowski; Luis Chiappetta
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Annals of surgery     Volume:  245     ISSN:  0003-4932     ISO Abbreviation:  Ann. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-01     Completed Date:  2007-02-12     Revised Date:  2013-06-06    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-7     Citation Subset:  AIM; IM    
Affiliation:
Surgical Division, University of Buenos Aires, Buenos Aires, Argentina. ocampoc@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Cholangiopancreatography, Endoscopic Retrograde*
Cholestasis / etiology,  radiography,  surgery*
Female
Gallstones / complications*,  radiography,  surgery
Humans
Male
Middle Aged
Pancreatitis / etiology,  radiography,  surgery*
Sphincterotomy, Endoscopic*
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
Curr Gastroenterol Rep. 2008 Apr;10(2):147-9   [PMID:  18462600 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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