Pancreatitis is a severe complication of gallstone disease with considerable mortality.
Small gallstones may increase the risk of pancreatitis.
Dr Karel van Erpecum and colleagues from the Netherlands evaluated the association of small stones with pancreatitis.
The researchers also assessed the potential beneficial effects of prophylactic cholecystectomy.
Stone characteristics were determined in 115 patients with biliary pancreatitis, 103 with obstructive jaundice due to gallstones, and 79 with acute cholecystitis.
|Gallstones less than 5 mm indicated that life-years may be gained or lost by cholecystectomy |
|American Journal of Gastroenterology|
The research team also determined stone characteristics in 231 with uncomplicated gallstone disease.
Sizes and numbers of gallbladder and bile duct stones were determined by ultrasonography and endoscopic retrograde cholangiopancreatography, respectively.
The researchers assessed the effects of prophylactic cholecystectomy by decision analyses with a Markov model and Monte Carlo simulations.
The team found that patients with pancreatitis or obstructive jaundice had more and smaller gallbladder stones than with acute cholecystitis or uncomplicated disease.
Bile duct stones were smaller in case of pancreatitis than in obstructive jaundice.
The team used multivariate analysis and identified old age and small stones as independent risk factors for pancreatitis.
Decision analysis in a representative group of patients with gallstones less than 5 mm indicated that life-years may be gained or lost by cholecystectomy.
The research team noted that this result depended on incidence and mortality of pancreatitis.
Dr van Erpecum's team concluded, “Small gallstones are associated with pancreatitis.”
“Prophylactic cholecystectomy may lead to gain or loss of life-years in patients with small stones, depending on incidence and mortality of pancreatitis.”