Reuters Health Information: Less recurrent pancreatitis seen with adherence to cholecystectomy guidelines
Less recurrent pancreatitis seen with adherence to cholecystectomy guidelines
Last Updated: 2017-02-23
By Lorraine L. Janeczko
NEW YORK (Reuters Health) - Treating biliary pancreatitis
according to cholecystectomy guidelines is associated with a
smaller risk of recurrence and later hospitalization, according
to new findings.
Guidelines state that patients with acute biliary
pancreatitis should undergo cholecystectomy during or within
four weeks of hospitalization, researchers note in the American
Journal of Gastroenterology, online January 10.
"Most patients received cholecystectomy consistent with the
guidelines," senior author Dr. Susan M. Huftless of Johns
Hopkins University in Baltimore, Maryland, told Reuters Health
"We recommend adherence to guidelines to reduce the risk of
gallstone pancreatitis,� added lead author Dr. Ayesha Kamal,
also of Johns Hopkins University. �Our findings suggest that
adherence to guideline-recommended cholecystectomy reduces the
risk of further hospitalization for gallstone pancreatitis and
thus can lower medical care cost."
For the study, the two researchers and their colleagues
analyzed records from the 2010-2013 MarketScan Commercial Claims
and Encounters database. They considered guideline adherence to
be cholecystectomy within 30 days of the first hospitalization
for biliary pancreatitis.
Seventy-eight percent of the more than 17,000 patients who
met the inclusion criteria were treated according to guideline
timeframes, including nearly 11,000 who had a cholecystectomy
during the first related hospitalization and 2,387 who had a
cholecystectomy within 30 days.
Of the 3,705 patients for whom guidelines were not followed,
a third had a cholecystectomy between one and six months after
the first hospitalization.
Patients treated according to guidelines had fewer future
hospitalizations for acute and chronic pancreatitis (acute
pancreatitis, 3% vs. 13%, p<0.001; chronic pancreatitis, 1% vs.
"These findings surprised me as I did not expect adherence
to the guidelines to be so high," Dr. Kamal told Reuters Health
Dr. Huftless noted. "The community is doing a great job of
getting patients into surgery rapidly in adherence with the
guidelines. This is a win for patients and shows that multiple
disciplines can work together to provide patients with
She said the one-year window after the first hospitalization
appears to be the riskiest.
"There is a real risk of delaying cholecystectomy, but with
well-formulated research, this is an area where personalized
medicine could be examined," Dr. Huftless advised. "At present,
the personalization of cholecystectomy timing is a hypothesis
and would need to be tested in rigorous studies. Until that
time, there is clear evidence that the guidelines are beneficial
to patients and should be followed."
"This is the largest study on this topic in the United
States, including privately insured individuals under age 65,"
Dr. Kamal pointed out that the database is limited by �the
lack of generalizability as it includes only insured individuals
under 65 years of age.�
Am J Gastroenterol 2017.