Author(s): Goh Y.M., Goh Y.L., Lapsia S., Reddy Y., Kaushik V., Harris C., Kausar A., Chang D., Subar D.
Abstract: Objectives: UK guidelines in the management of acute gallstone pancreatitis (GSP) with cholangitis, jaundice, a predicted or actual severe attack or dilated common bile duct (CBD) warrants an endoscopic retrograde cholangiopancreaticogram (ERCP) and sphincterotomy +/- stone extraction or stenting within 72 h of the onset of pain. However about 50% of CBD stones will pass spontaneously. The aim of this study was to assess factors predictive of CBD stones in GSP. Methods: This is a retrospective study of all patients presenting with GSP over a 4 year period from January 2010 to October 2014. Patients were identified using NHS coding K85 and K80.2. Data on admission blood tests (C-reactive protein (CRP) and liver function test), imaging (ultrasound (USS) magnetic resonance cholangiopancreaticogram (MRCP) and ERCP) results and severity of pancreatitis were collected. All categorical variables were analysed with Chi square or Fisher's exact test. Continuous variables were analysed with logistic regression. Statistical analysis was conducted using SPSSv20. Results: 239 patients presented with GSP over the study period. The mean age was 60.5 17.8 years. The male to female ratio was 80:165. 35 patients had predicted severe pancreatitis. 98 patients went on to have ERCP. Only elevated bilirubin (>22 mumol/L) was predictive of CBD stones on MRCP (p = 0.035). The presence of a dilated CBD (p = 0.033) or stone (p < 0.05) on MRCP was predictive of a stone on ERCP. The severity of the pancreatitis did not predict the presence of CBD stones (p = 0.133). Conclusion: Patients who present with GSP should have further investigations to confirm the presence of CBD stones before proceeding to ERCP except in cases of worsening or unresolving obstructive biliopathy or cholangitis.
Publication Type: Journal: Conference Abstract