COMMENTARY

Top 10 Practice Changers in Gastroenterology: 2015

David A. Johnson, MD

Disclosures

December 29, 2015

In This Article

Author's Note:
This year has seen considerable advances in gastroenterology, ranging from diagnostic and testing changes to therapeutic changes. I have summarized what I believe to be this year's 10 must-read articles, because they represent new guidance for clinical practice.

Same-Admission Versus Interval Cholecystectomy for Mild Gallstone Pancreatitis (PONCHO): A Multicentre Randomised Controlled Trial

da Costa DW, Bouwense SA, Schepers NJ, et al; Dutch Pancreatitis Study Group
Lancet. 2015;386:1261-1268

When Should You Perform Cholecystectomy for Mild Gallstone Pancreatitis?

Although guidelines and surgical textbooks recommend prompt cholecystectomy for mild gallstone pancreatitis during the index hospitalization, most patients in the United States undergo cholecystectomy several weeks after discharge.

In this randomized trial, cholecystectomy was performed during the initial hospitalization or after discharge (mean, 4 weeks). Gallstone-related complications (including recurrent pancreatitis) and related mortality occurred significantly less in the same-admission group vs the interval delay group (5% vs 17%, respectively). Notably, there were no differences in length of hospital stay or rate of surgical complications between groups.

These findings demonstrate that the common practice of delaying cholecystectomy in patients presenting with mild gallstone pancreatitis leads to much higher rates of preventable, recurrent, stone-related complications, compared with a strategy of performing cholecystectomy during the index hospitalization. Surgeons should not be reluctant to perform cholecystectomy before discharge in these patients. Gastroenterologists are typically consulted on these patients and, therefore, should be aware of this randomized trial that represents a major change from current practice.

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