4 Questions About the Timing of Cholecystectomy

Cholecystectomy (CCY) reduces the risk of recurrent gallstone-related complications among individuals with acute biliary pancreatitis. However, guidelines vary on the ideal timing of CCY in patients with acute gallstone pancreatitis.

Mohammed Absar Ullah, MD, a gastroenterology fellow at the University of Rochester in Rochester, New York, and colleagues conducted a retrospective chart review of 234 patients with acute biliary pancreatitis to determine when cholecystectomy (CCY) should be performed.

Gastroenterology Consultant spoke with Dr Absar Ullah and his coauthor, Shivangi Kothari, MD, an associate professor of medicine and associate director of endoscopy at the University of Rochester Medical Center, about the research that was presented at Digestive Disease Week (DDW) 2019.

Gastroenterology Consultant: What prompted you to conduct the study?

Mohammed Absar Ullah and Shivangi Kothari: The idea for our study was borne out of curiosity. Our division sees a number of patients who present with biliary events such as gallstone pancreatitis. We often perform endoscopic retrograde cholangiopancreatography (ERCP) then refer them for CCY to prevent further episodes. Current guidelines vary on the timing of CCY, with recommendations ranging from performing the procedure during the index hospitalization to up to 4 weeks after discharge. We know there is a clear correlation between timing of CCY and recurrent biliary events. So although we often make the aforementioned recommendation regarding early CCY, we wanted to get a sense of how our institution was doing in this regard.

GASTRO CON: What do you think is the most important finding?

MU and SK: Among patients who had not undergone CCY during the index hospitalization, we noted a recurrent biliary event rate of 19%. Moreover, when taking into account the time to CCY from index hospitalization, we noted that all recurrent events occurred beyond 30 days, with most occurring beyond 60 days. This lends further credence to the fact that performing CCY during the index hospitalization—or as soon as possible within a 30-day window—is the most effective strategy to help reduce the rate of recurrent biliary events.

GASTRO CON: How can a gastroenterologist or specialist apply these findings to clinical practice?

MU and SK: Our study serves to further emphasize that timing is crucial regarding CCY to prevent further biliary events after gallstone pancreatitis. ERCP is crucial in managing such patients, but ultimately, rendering effective care requires a multidisciplinary approach. As practicing gastroenterologists, we need to work closely with our surgical colleagues to prevent recurrent biliary events in these patients. Communication and planning is key.

GASTRO CON: What are the next steps of your research?

MU and SK: Our results are a first step towards the goal of quality improvement. We hope to take a more prospective approach now—we plan on discussing our findings with our surgical colleagues, after which we intend to measure changes in practice patterns, along with its impact on recurrent biliary events.

Read more about the study here.

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