Multimodal approach to mild biliary pancreatitis based on a risk stratification of choledocholithiasis.

AIM: The management of acute mild biliary pancreatitis is multidisciplinary and
still presents controversies in the diagnostic and therapeutic strategies. The
aim of this retrospective study is to establish if a risk stratification of
choledocholithiasis can optimize the employment of technological resources and
medical competence in the treatment of individual patients in a tailored way. Our
personal experience has then been compared with international literature. The
main end-point was to evaluate the incidence of recurrence of acute pancreatitis.
Secondary end point was to propose an affordable diagnostic and therapeutic
algorithm for this relatively common disease.
METHODS: One hundred and one (101) patients affected by acute mild biliary
pancreatitis were admitted in the Department of Patologia Chirurgica of "Ospedale
SS. Annunziata" of Chieti from January 2004 to June 2011. Patients were divided
in three groups; high (I), medium (II) and low risk (III) of choledocholithiasis
(CBDS) according to clinical, laboratory and instrumental criteria. On the base
of this division, patients in group I were subjected to ERCP with endoscopic
sphinterotomy (ES) and subsequent laparoscopic cholecystectomy (LC). Group II
patients underwent to MRCP, if positive for CBDS followed by ES and subsequently
LC, if negative for CBDS directly LC. Group III patients underwent directly to LC
associated with intra-operative cholangiography in selected cases.
RESULTS: No recurrence of acute pancreatitis was observed in patients who
completed the diagnostic and therapeutic procedures.
CONCLUSION: We believe that the application of a patient stratification in risk
groups for choledocholithiasis can optimize the use of medical and technological
resources and helps to address a patient for a specific and more appropriate
diagnostic and therapeutic investigation allowing, at the same time, to identify
patients who can usefully undergo to a simplified diagnostic and therapeutic
approach.