ERCP and Endoscopic Sphincterotomy (ES): A Safe and Definitive Management of Gallstone Pancreatitis with the Gallbladder Left In Situ

Background and Aims UK guidelines recommend that patients with gallstone pancreatitis have cholecystectomy within 2 weeks of their pancreatitis. A proportion of these are elderly with significant comorbidities rendering them high risk for general anaesthesia and surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) may offer a safe alternative to cholecystectomy as definitive treatment in these patients. Patients and Methods A retrospective review of all cases of gallstone pancreatitis presenting between 1999 and 2009 was undertaken. Results One hundred one patients underwent ERCP and ES as a definitive treatment for gallstone pancreatitis with a median age of 78 years (range, 43-96 years) and a median American Society of Anesthesiologists grade of 2. Three patients died from pancreatitis despite successful ERCP. Eighty-nine patients were successfully treated with an ERCP alone, and 84 patients (94%) had no recurrence of pancreatitis with a mean follow-up of 41 months (+/-32 months, range 4-118 months). The total patient follow-up was 3,260 months. Twenty-seven patients (33%) died within the follow-up period of unrelated causes, explaining the lower than expected median follow-up. Five patients had a recurrence of pancreatitis during follow-up (6%). Conclusion ERCP with ES is a safe alternative to laparoscopic cholecystectomy to prevent further attacks of gallstone pancreatitis in high-risk surgical patients and the elderly.