Gallstone pancreatitis: Sixteen years of clinical management

Of 1465 patients with cholelithiasis admitted from 1980 to 1995, we reviewed 49 patients (3.3%) with gallstone pancreatitis. The patients were 26 men and 23 women, with a mean age of 57.7 years and mean serum amylase level of 2195 IU/l. We examined laboratory data needed to determine Ranson's score, and we examined clinical findings, including the timing and choice of treatment, site of gallstones, and the postoperative course. Thirty-five patients (72%) were classified as having mild pancreatitis, with a Ranons's score of 2 or less; 9 patients (18%) had severe pancreatitis (score of 3 or more), and the remaining 5 (10%) could not be classified. Common bile duct (CBD) stones were identified in 18 of the 49 patients (37%) and the incidence of CBD stones was 67% in patients with severe pancreatitis, more than two times higher than that in patients with mild pancreatitis (31%). Although 92% of the patients (45/49) recovered from pancreatitis initially with conservative treatment, such as antibiotics and protease inhibitors; 4 of the 9 patients with severe pancreatitis (44%) required urgent treatment. After the pancreatitis settled, cholecystectomy, predominantly performed laparoscopically, and endoscopic sphincterotomy were the primary treatment procedures. The overall morbidity rate was 6% (mild pancreatitis, 6%; severe pancreatitis, 11%), with no mortality. Most mild pancreatitis and some severe gallstone pancreatitis can be treated conservatively, followed by treatment for the gallstones causing the acute pancreatitis. However, in some patients with severe pancreatitis, especially those with acute necrotizing pancreatitis or suppurative cholangitis, urgent treatment is mandatory. The final treatment for gallstones should be performed after the pancreatitis is alleviated.