Scholarlink

Background <p>The optimal management strategy for mild acute biliary pancreatitis (ABP) in older adults, particularly in those with contraindications to cholecystectomy, remains uncertain. Early cholecystectomy is the standard strategy to reduce recurrent biliary events, whereas endoscopic sphincterotomy (ES) may be used as a&#xa0;nonoperative biliary intervention in carefully selected patients who are not candidates for definitive surgery. This study evaluated the long-term outcomes associated with ES in older adults with mild ABP.</p> Methods <p>We conducted a&#xa0;retrospective cohort study of patients aged ≥ 70&#xa0;years admitted with mild ABP between 2010 and 2020. Patients were stratified into two groups based on treatment modality: ERCP with ES versus conservative management. Primary outcomes included recurrence of pancreatitis, overall survival, and ERCP-related morbidity. Secondary outcomes were biliary complications and readmission rates. Statistical analyses included Kaplan–Meier survival curves, multivariable Cox proportional hazards models, and competing-risk analyses. Patients were included on the basis of advanced age and real-world treatment allocation; the cohort was not intended to represent all older adults with ABP who would otherwise be candidates for surgery.</p> Results <p>A&#xa0;total of 182 patients (median age: 78&#xa0;years) were included, with 90&#xa0;undergoing ERCP with ES and 92&#xa0;managed conservatively. Recurrence rates were similar (ES: 8.9% vs. conservative management: 8.7%; <i>p</i> = 0.94). Overall mortality did not differ significantly between the groups (HR: 1.12; 95% CI: 0.73–1.67). Median survival was 60&#xa0;months in the ES group and 50&#xa0;months in the conservative management group (<i>p</i> = 0.21). Readmission rates and biliary event frequencies were also comparable. The ERCP-related morbidity was 5.6%. These findings should be interpreted cautiously given the retrospective design, limited sample size, and absence of a&#xa0;formal frailty metric.</p> Conclusion <p>In selected older adults with mild ABP who were managed without cholecystectomy, ES did not show a&#xa0;statistically significant reduction in recurrence or mortality compared to conservative management. These data do not establish noninferiority of conservative management but rather suggest that outcomes may be comparable in highly selected patients for whom definitive surgery is not pursued. Further prospective studies incorporating frailty assessment and clearer treatment selection criteria are needed.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Outcomes of non-surgical management in older adults with mild acute biliary pancreatitis: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年5月27日

查看全文
  • Tolga Canbak,
  • Aylin Acar,
  • Fatih Başak,
  • Gürhan Baş

摘要

Background

The optimal management strategy for mild acute biliary pancreatitis (ABP) in older adults, particularly in those with contraindications to cholecystectomy, remains uncertain. Early cholecystectomy is the standard strategy to reduce recurrent biliary events, whereas endoscopic sphincterotomy (ES) may be used as a nonoperative biliary intervention in carefully selected patients who are not candidates for definitive surgery. This study evaluated the long-term outcomes associated with ES in older adults with mild ABP.

Methods

We conducted a retrospective cohort study of patients aged ≥ 70 years admitted with mild ABP between 2010 and 2020. Patients were stratified into two groups based on treatment modality: ERCP with ES versus conservative management. Primary outcomes included recurrence of pancreatitis, overall survival, and ERCP-related morbidity. Secondary outcomes were biliary complications and readmission rates. Statistical analyses included Kaplan–Meier survival curves, multivariable Cox proportional hazards models, and competing-risk analyses. Patients were included on the basis of advanced age and real-world treatment allocation; the cohort was not intended to represent all older adults with ABP who would otherwise be candidates for surgery.

Results

A total of 182 patients (median age: 78 years) were included, with 90 undergoing ERCP with ES and 92 managed conservatively. Recurrence rates were similar (ES: 8.9% vs. conservative management: 8.7%; p = 0.94). Overall mortality did not differ significantly between the groups (HR: 1.12; 95% CI: 0.73–1.67). Median survival was 60 months in the ES group and 50 months in the conservative management group (p = 0.21). Readmission rates and biliary event frequencies were also comparable. The ERCP-related morbidity was 5.6%. These findings should be interpreted cautiously given the retrospective design, limited sample size, and absence of a formal frailty metric.

Conclusion

In selected older adults with mild ABP who were managed without cholecystectomy, ES did not show a statistically significant reduction in recurrence or mortality compared to conservative management. These data do not establish noninferiority of conservative management but rather suggest that outcomes may be comparable in highly selected patients for whom definitive surgery is not pursued. Further prospective studies incorporating frailty assessment and clearer treatment selection criteria are needed.