Gallstone Pancreatitis: Admission versus Normal Cholecystectomy - a Randomized Trial (Gallstone PANC Trial)
Krislynn Mueck*, Shuyan Wei*, Claudia Pedroza*, Karla Bernardi*, Margaret L. Jackson*, Mike K. Liang*, Tien C. Ko*, Lillian S. Kao
UTHSC Houston, Houston, TX
INTRODUCTION: Early cholecystectomy for mild gallstone pancreatitis (MGP) shortly after admission has been proposed based on observational data. We hypothesized that cholecystectomy within 24 hours of admission versus after clinical resolution of MGP results in decreased length-of-stay (LOS) without an increase in complications.
METHODS: Adults with MGP were randomized to cholecystectomy with cholangiogram within 24 hours of presentation (early group) versus after clinical resolution (late group). Primary outcome was 30-day LOS including any readmissions. Secondary outcomes were time to surgery, endoscopic retrograde cholangiopancreatography (ERCP) rates, and post-operative complications. Frequentist and Bayesian intention-to-treat analyses were performed.
RESULTS: Baseline characteristics were similar in the early (n=49) and late (n=48) groups. Early group had fewer ERCPs (15% vs 29%, p = 0.038), faster time to surgery (16 hours vs 43 hours, p<0.005), and shorter 30-day LOS (50 hours vs 77 hours, p<0.005). There was no significant difference in complications (6% early vs 2% late, p=0.613) which included recurrence/progression of pancreatitis (2 early, 1 late) and a cystic stump leak (early). On Bayesian analysis, early cholecystectomy has a 99% probability of reducing 30-day LOS, 93% probability of decreasing ERCP use, and 72% probability of increasing complications.
CONCLUSIONS: In patients with MGP, cholecystectomy within 24 hours of admission significantly reduced rate of ERCPs, time to surgery, and 30-day length-of-stay. Complications may be increased but the study is underpowered to detect a difference. Identification of patients with MGP in whom early cholecystectomy is safe warrants further investigation.
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* By Invitation
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