Gallstone Pancreatitis: How Does Management Differ from Other Causes of Acute Pancreatitis?

  • Lindsea Abbott
  • Travis A. Thompson


Acute gallstone pancreatitis is treated differently than other causes of pancreatitis. Since there is a potential physical obstruction, further imaging with an abdominal ultrasound is recommended. Treatment recommendations rely heavily on imaging findings and ancillary laboratory evaluation. The most severe cases may require ERCP and cholecystectomy, while milder cases may only require a cholecystectomy within 7 days of symptom resolution.


Gallstones Pancreatitis ERCP 


  1. 1.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.CrossRefGoogle Scholar
  2. 2.
    Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33(4):323–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–61.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Párniczky A, Kui B, Szentesi A, Balázs A, Szűcs Á, Mosztbacher D, et al. Prospective, multicentre, nationwide clinical data from 600 cases of acute pancreatitis. PLoS One. 2016;11(10):e0165309.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Moreau JA, Zinsmeister AR, Melton LJ 3rd, DiMagno EP. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study. Mayo Clin Proc. 1988;63(5):466–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Tenner S, Baillie J, De Witt J, Vege SS, American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15;1416.CrossRefGoogle Scholar
  7. 7.
    Lee DWH, Chan ACW, Lam Y-H, Ng EKW, Lau JYW, Law BKB, et al. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial. Gastrointest Endosc. 2002;56(3):361–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee BS, Hwang J-H, Lee SH, Jang SE, Jang ES, Jo HJ, et al. Risk factors of organ failure in patients with bacteremic cholangitis. Dig Dis Sci. 2013;58(4):1091–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Greenberg JA, Hsu J, Bawazeer M, Marshall J, Friedrich JO, Nathens A, et al. Clinical practice guideline: management of acute pancreatitis. Can J Surg. 2016;59(2):128–40.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–15.Google Scholar
  11. 11.
    Tenner S, Dubner H, Steinberg W. Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis. Am J Gastroenterol. 1994;89(10):1863–6.PubMedGoogle Scholar
  12. 12.
    Baj J, Radzikowska E, Maciejewski M, Dąbrowski A, Torres K. Prediction of acute pancreatitis in the earliest stages – role of biochemical parameters and histopathological changes. Pol Przegl Chir. 2017;89(2):31–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Contractor QQ, Boujemla M, Contractor TQ, el-Essawy OM. Abnormal common bile duct sonography. The best predictor of choledocholithiasis before laparoscopic cholecystectomy. J Clin Gastroenterol. 1997;25(2):429–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Baron RL, Stanley RJ, Lee JK, Koehler RE, Melson GL, Balfe DM, et al. A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography. Radiology. 1982;145(1):91–8.PubMedCrossRefGoogle Scholar
  15. 15.
    ASGE Standards of Practice Committee, Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9.CrossRefGoogle Scholar
  16. 16.
    Hunt DR. Common bile duct stones in non-dilated bile ducts? An ultrasound study. Australas Radiol. 1996;40(3):221–2.PubMedCrossRefGoogle Scholar
  17. 17.
    Costi R, Sarli L, Caruso G, Iusco D, Gobbi S, Violi V, et al. Preoperative ultrasonographic assessment of the number and size of gallbladder stones. J Ultrasound Med. 2002;21(9):971–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Petrov MS, van Santvoort HC, Besselink MGH, van der Heijden GJMG, van Erpecum KJ, Gooszen HG. Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg. 2008;247(2):250–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Barlow AD, Haqq J, McCormack D, Metcalfe MS, Dennison AR, Garcea G. The role of magnetic resonance cholangiopancreatography in the management of acute gallstone pancreatitis. Ann R Coll Surg Engl. 2013;95(7):503–6.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Gurusamy KS, Giljaca V, Takwoingi Y, Higgie D, Poropat G, Štimac D, et al. Ultrasound versus liver function tests for diagnosis of common bile duct stones. Cochrane Database Syst Rev. 2015;2:CD011548.Google Scholar
  21. 21.
    Kulvatunyou N, Watt J, Friese RS, Gries L, Green DJ, Joseph B, et al. Management of acute mild gallstone pancreatitis under acute care surgery: should patients be admitted to the surgery or medicine service? Am J Surg. 2014;208(6):981–7; discussion 986–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut. 2017;66(5):765–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis. Cochrane Database Syst Rev. 2012.Google Scholar
  24. 24.
    Zidi SH, Prat F, Le Guen O, Rondeau Y, Rocher L, Fritsch J, et al. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut. 1999;44(1):118–22.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB, et al. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg. 2012;255(5):860–6.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Nealon WH, Bawduniak J, Walser EM. Appropriate timing of cholecystectomy in patients who present with moderate to severe gallstone-associated acute pancreatitis with peripancreatic fluid collections. Ann Surg. 2004;239(6):741–9; discussion 749–51.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Lindsea Abbott
    • 1
  • Travis A. Thompson
    • 1
  1. 1.MedStar Washington Hospital Center, Department of Emergency MedicineWashington, DCUSA

Personalised recommendations