This population-based cohort study used Swedish nationwide registry data (2006–2019) to compare same-admission cholecystectomy, ERCP only, and no intervention in 9,593 adults with a first episode of mild gallstone-related acute pancreatitis (hospital stay ≤10 days), with primary outcome of recurrent acute pancreatitis and secondary outcome of other gallstone-related complications.
Recurrent acute pancreatitis occurred in 3.4% (cholecystectomy), 4.9% (ERCP only), and 17.5% (no intervention); adjusted sHR vs. cholecystectomy was 1.40 (95% CI, 1.02–1.92) for ERCP only and 6.06 (95% CI, 4.85–7.56) for no intervention. Other gallstone-related complications (cholecystitis/choledocholithiasis) occurred in 1.6%, 19.9%, and 16.3%, respectively. ERCP-only recurrence risk peaked at 8–14 days post-discharge; beyond 15 days, recurrence rates were similar to cholecystectomy.
- Observational design limits causal inference; residual confounding by surgical fitness or disease severity cannot be excluded. - Only patients with stays ≤10 days were included, so findings may not apply to more severe cases. - Full text is embargoed; some methodological details (e.g., comorbidity adjustment specifics, loss to follow-up) could not be verified.
Prioritize same-admission cholecystectomy for all fit patients with mild gallstone-related acute pancreatitis — it carries the lowest risk of recurrence and gallstone complications. If surgery must be deferred, watch closely in the first 2 weeks post-discharge, as ERCP-only patients face peak recurrence risk at 8–14 days.
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