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Gallstone pancreatitis refers to pancreatitis caused by gallstones, specifically distal choledocholithiasis. Gallstones are the cause for 35-40% of acute pancreatitis but this number has a wide regional variance.
Gallstone pancreatitis has a higher incidence in women (compared to alcohol-induced pancreatitis, which has a higher incidence in men) 4.
The exact pathophysiology of gallstone pancreatitis remains unclear. There are a number of theories 2,3:
- distal gallstone obstruction results in pancreatic duct obstruction, this results in increased pancreatic duct pressure and unregulated pancreatic enzyme activity
- acinar cell hyperstimulation has also been implicated
- infected bile reflux inducing pancreatic enzyme action
Treatment and prognosis
Treatment options vary but include:
- conservative management
- may be performed acutely during the index admission, or after a short interval after discharge
- If gallstones are not treated, recurrence occurs in ~45% (range 32-61%) 4
- Meta-analysis show no benefit of routine ERCP in gallstone pancreatitis in the absence of biliary obstruction or cholangitis 5