Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
Pancreatology. 2019 Jun;19(4):524-530. doi: 10.1016/j.pan.2019.04.008. Epub 2019 Apr 22.
BACKGROUND/OBJECTIVES: Gallstones are the leading cause of acute pancreatitis in developed countries. National and international guidelines recommend that a cholecystectomy should be performed during the index hospitalization for acute gallstone pancreatitis. We aimed to delineate the national trends for same-admission cholecystectomy and ERCP for acute gallstone pancreatitis over the last ten years.
We used the 2004, 2009 and 2014 National Inpatient Sample database including patients with a principal diagnosis of acute pancreatitis and a secondary diagnosis of choledocholithiasis or cholelithiasis. Exclusion criteria were age <18 years and elective admission. Primary outcome was the trend in incidence rate of same admission cholecystectomy from 2004 to 2014. The secondary outcomes were: 10-year trend in 1) Incidence of gallstone pancreatitis, 2) proportion of gallstone pancreatitis compared to all other etiologies of acute pancreatitis, 3) incidence rate of same-admission ERCP, 4) length of hospital stay, and 5) total hospitalization costs and charges.
The proportion of admissions during which a same-admission cholecystectomy was performed decreased from 48.7% in 2004 to 46.9% in 2009 to 45% in 2014 (trend p < 0.01). During the same time interval, the percentage of admissions during which an ERCP was performed decreased from 25.1% to 18.7% (Trend p < 0.01).
Adherence to the guidelines for same-admission cholecystectomy for patients admitted with acute gallstone pancreatitis have been declining over the past decade. On the other hand, decline in rate of ERCP in patients with acute gallstone pancreatitis and no signs of cholangitis demonstrates adherence to guidelines in this regard.
背景/目的：在发达国家，胆石症是急性胰腺炎的主要病因。国家和国际指南建议在急性胆石性胰腺炎的住院期间进行胆囊切除术。我们旨在描绘过去十年中急性胆石性胰腺炎患者同期行胆囊切除术和 ERCP 的全国趋势。
我们使用了 2004 年、2009 年和 2014 年全国住院患者样本数据库，其中包括主要诊断为急性胰腺炎和次要诊断为胆总管结石或胆石症的患者。排除标准为年龄<18 岁和择期入院。主要结局是 2004 年至 2014 年同期行胆囊切除术的发病率趋势。次要结局为：10 年趋势 1）胆石性胰腺炎的发病率，2）胆石性胰腺炎占所有急性胰腺炎病因的比例，3）同期行 ERCP 的发病率，4）住院时间，5）总住院费用和费用。
同期行胆囊切除术的入院比例从 2004 年的 48.7%下降到 2009 年的 46.9%，再到 2014 年的 45%（趋势 p<0.01）。在同一时间间隔内，同期行 ERCP 的入院比例从 25.1%下降到 18.7%（趋势 p<0.01）。
过去十年中，急性胆石性胰腺炎患者接受同期胆囊切除术的指南遵循率一直在下降。另一方面，急性胆石性胰腺炎且无胆管炎迹象的患者 ERCP 率下降表明在这方面遵循了指南。
