Gallstone pancreatitis
Last revised by Jeremy Jones on 20 Sep 2021
Citation, DOI, disclosures and article data
Citation:
Knipe H, Worsley C, Elfeky M, et al. Gallstone pancreatitis. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-35488
Permalink:
rID:
35488
Article created:
Disclosures:
At the time the article was created Henry Knipe had no recorded disclosures.
View Henry Knipe's current disclosures
Last revised:
20 Sep 2021,
Jeremy Jones ◉
Disclosures:
At the time the article was last revised Jeremy Jones had no recorded disclosures.
View Jeremy Jones's current disclosures
Revisions:
7 times, by
5 contributors -
see full revision history and disclosures
Systems:
Synonyms:
- Gallstone-induced pancreatitis
- Biliary pancreatitis
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.
On this page:
Epidemiology
Gallstone pancreatitis has a higher incidence in women (compared to alcohol-induced pancreatitis, which has a higher incidence in men) 4.
Pathology
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
-
cholecystectomy
- 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
-
ERCP
- Meta-analysis show no benefit of routine ERCP in gallstone pancreatitis in the absence of biliary obstruction or cholangitis 5
References
- 1. Vitale GC. Early management of acute gallstone pancreatitis. Ann. Surg. 2007;245 (1): 18-9. doi:10.1097/01.sla.0000250967.32581.c9 - Free text at pubmed - Pubmed citation
- 2. Wang GJ, Gao CF, Wei D et-al. Acute pancreatitis: etiology and common pathogenesis. World J. Gastroenterol. 2009;15 (12): 1427-30. Free text at pubmed - Pubmed citation
- 3. Hazem ZM. Acute biliary pancreatitis: diagnosis and treatment. Saudi J Gastroenterol. 2009;15 (3): 147-55. doi:10.4103/1319-3767.54740 - Free text at pubmed - Pubmed citation
- 4. Sekimoto M, Takada T, Kawarada Y et-al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006;13 (1): 10-24. doi:10.1007/s00534-005-1047-3 - Free text at pubmed - Pubmed citation
- 5. Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. (2012) The Cochrane database of systematic reviews. doi:10.1002/14651858.CD009779.pub2 - Pubmed
- 6. Bortoff GA, Chen MY, Ott DJ et-al. Gallbladder stones: imaging and intervention. Radiographics. 2000;20 (3): 751-66. doi:10.1148/radiographics.20.3.g00ma16751 - Pubmed citation
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