Abstract | BACKGROUND: METHODS: We abstracted data from medical records of all Olmsted county residents who underwent cholecystectomy at Mayo Clinic for the management of presumed gallstone or idiopathic AP between 1990 and 2005 (n = 239). Based on (i) significantly elevated liver enzymes (≥threefold increase of alanine aminotransferase or aspartate aminotransferase) on day 1 and (ii) the presence of gallstones/sludge in the gall bladder, we categorized patients into 4 groups: A (i + ii), B (i but not ii), C (ii but not i), and D (neither i nor ii). Recurrence rates of AP after cholecystectomy were determined in all groups. RESULTS: The median follow-up after cholecystectomy was 99 months (range, 8-220). AP recurred in 13 of 142 patients (9%) in group A, 1 of 17 patients (6%) in group B, 13 of 57 patients (23%) in group C, and 14 of 23 patients (61%) in group D (P < .0001 D vs. all other groups and P = .001 C vs. groups A and B). No difference was seen in recurrence rates in groups A vs. B (P = 1.0). Recurrences were more frequent in patients with normal liver enzymes (A + B vs. C + D; P = .000003) and in patients without sonographic evidence of gallstones/sludge (A + C vs. B + D; P = .0008). CONCLUSION: When AP is associated with significantly elevated liver enzymes on day 1, recurrence rates after cholecystectomy are low (9%). However, postcholecystectomy recurrence rates of AP are high in those without such laboratory abnormalities (34%), especially in those without gall bladder stones/sludge (61%) on abdominal ultrasonography. Our results raise doubts about the efficacy of cholecystectomy to prevent recurrent AP in patients with the absence of either a significant elevation of liver tests on day 1 of AP or gallstones and/or sludge in the gall bladder on initial ultrasound examination.
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Authors | Jan Trna, Santhi Swaroop Vege, Veronika Pribramska, Suresh T Chari, Patrick S Kamath, Michael L Kendrick, Michael B Farnell |
Journal | Surgery
(Surgery)
Vol. 151
Issue 2
Pg. 199-205
(Feb 2012)
ISSN: 1532-7361 [Electronic] United States |
PMID | 21975288
(Publication Type: Journal Article)
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Copyright | Copyright © 2012 Mosby, Inc. All rights reserved. |
Chemical References |
- Biomarkers
- Aspartate Aminotransferases
- Alanine Transaminase
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Topics |
- Acute Disease
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Alanine Transaminase
(metabolism)
- Aspartate Aminotransferases
(metabolism)
- Bile
(diagnostic imaging)
- Biomarkers
(metabolism)
- Cholecystectomy
- Female
- Follow-Up Studies
- Gallstones
(diagnostic imaging, surgery)
- Humans
- Incidence
- Liver
(enzymology)
- Male
- Middle Aged
- Pancreatitis
(epidemiology, prevention & control)
- Predictive Value of Tests
- Retrospective Studies
- Secondary Prevention
- Sensitivity and Specificity
- Treatment Outcome
- Ultrasonography
- Young Adult
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