Early endoscopic retrograde cholangiopancreatography in mild gallstone pancreatitis with deranged liver function test. A 7-year experience in central Saudi Arabia

OBJECTIVE: To determine the use of liver function tests (LFTs) as a selection tool for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with mild gallstone pancreatitis.

METHODS: All patients admitted with mild gallstone pancreatitis with deranged LFTs in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2006 and February 2013 were studied retrospectively. Patients' demography, symptoms, laboratory values, imaging studies, ERCP findings, complications and its treatment, surgical intervention, intraoperative and postoperative findings, mortality, and outpatient follow up were collected and analyzed.

RESULTS: A total of 245 patients were admitted as mild gallstone pancreatitis with admission day deranged LFTs. Pre-operative ERCP was performed in 74 patients based on admission day LFTs (Group A). Endoscopic retrograde cholangiopancreatography was normal in 65 patients, revealed stones in 5, and sludge in 4 patients. Six patients developed ERCP complications. Endoscopic retrograde cholangiopancreatography was deferred in 171 patients (Group B) until the LFTs were repeated in 3-4 days. Liver function tests remained persistently high in 8 patients. They were submitted to preoperative ERCP, which revealed stones (n=5) and sludge (n=3). Patients with normalized LFTs (n=163) were not submitted to ERCP. Three of them developed gallstone related complications.

CONCLUSION: Patients admitted with predicted mild gallstone pancreatitis, deranged LFTs, and no evidence of cholangitis should not be submitted to ERCP unless a repeat LFT within 3-4 days shows persistently deranged LFTs. This will reduce unnecessary ERCP and its complications.