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Article: Biliary sludge as a cause of acute pancreatitis

TitleBiliary sludge as a cause of acute pancreatitis
Authors
Issue Date1992
PublisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/
Citation
New England Journal Of Medicine, 1992, v. 326 n. 9, p. 589-593 How to Cite?
AbstractBackground. In about 20 to 40 percent of cases of acute pancreatitis, no cause can be found, and these are labeled idiopathic. In this study, we sought to determine the frequency with which patients with acute idiopathic pancreatitis have biliary sludge, a suspension of cholesterol monohydrate crystals or calcium bilirubinate granules that is found predominantly in the gallbladder. Methods. Between 1980 and 1988, we prospectively studied 86 patients who had acute pancreatitis. In patients with no known cause of pancreatitis and no ultrasonographic evidence of gallstones or dilatation of the biliary ducts, we determined how often biliary sludge was present and its subsequent fate by repeated microscopical examinations of bile samples and abdominal ultrasonography. The outcome of patients treated by cholecystectomy or papillotomy was compared with that of untreated patients. Results. The pancreatitis was considered idiopathic in 31 of the 86 patients (36 percent), of whom 23 had microscopical evidence of biliary sludge. Biliary sludge was detected by ultrasonography in only 11 of the 23 patients (48 percent). The sludge detected by ultrasonography was composed of calcium bilirubinate granules in 10 and cholesterol monohydrate crystals in 1 (P = 0.003). Calcium bilirubinate granules were found more frequently in men (nine men vs. four women, P<0.001). Of the 21 patients in whom biliary sludge was the only finding (2 patients also had dilated bile ducts when restudied), the 6 treated by cholecystectomy and the 4 treated by papillotomy had fewer recurrences of acute pancreatitis during follow-up (up to seven years) than the 11 untreated patients (P = 0.011). The presence of biliary sludge appeared to increase the likelihood of recurrent attacks of pancreatitis (P = 0.020). Conclusions. Biliary sludge is an underestimated cause of acute idiopathic pancreatitis.
Persistent Identifierhttp://hdl.handle.net/10722/175674
ISSN
2015 Impact Factor: 59.558
2015 SCImago Journal Rankings: 14.619
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLee, SPen_US
dc.contributor.authorNicholls, JFen_US
dc.contributor.authorPark, HZen_US
dc.date.accessioned2012-11-26T09:00:25Z-
dc.date.available2012-11-26T09:00:25Z-
dc.date.issued1992en_US
dc.identifier.citationNew England Journal Of Medicine, 1992, v. 326 n. 9, p. 589-593en_US
dc.identifier.issn0028-4793en_US
dc.identifier.urihttp://hdl.handle.net/10722/175674-
dc.description.abstractBackground. In about 20 to 40 percent of cases of acute pancreatitis, no cause can be found, and these are labeled idiopathic. In this study, we sought to determine the frequency with which patients with acute idiopathic pancreatitis have biliary sludge, a suspension of cholesterol monohydrate crystals or calcium bilirubinate granules that is found predominantly in the gallbladder. Methods. Between 1980 and 1988, we prospectively studied 86 patients who had acute pancreatitis. In patients with no known cause of pancreatitis and no ultrasonographic evidence of gallstones or dilatation of the biliary ducts, we determined how often biliary sludge was present and its subsequent fate by repeated microscopical examinations of bile samples and abdominal ultrasonography. The outcome of patients treated by cholecystectomy or papillotomy was compared with that of untreated patients. Results. The pancreatitis was considered idiopathic in 31 of the 86 patients (36 percent), of whom 23 had microscopical evidence of biliary sludge. Biliary sludge was detected by ultrasonography in only 11 of the 23 patients (48 percent). The sludge detected by ultrasonography was composed of calcium bilirubinate granules in 10 and cholesterol monohydrate crystals in 1 (P = 0.003). Calcium bilirubinate granules were found more frequently in men (nine men vs. four women, P<0.001). Of the 21 patients in whom biliary sludge was the only finding (2 patients also had dilated bile ducts when restudied), the 6 treated by cholecystectomy and the 4 treated by papillotomy had fewer recurrences of acute pancreatitis during follow-up (up to seven years) than the 11 untreated patients (P = 0.011). The presence of biliary sludge appeared to increase the likelihood of recurrent attacks of pancreatitis (P = 0.020). Conclusions. Biliary sludge is an underestimated cause of acute idiopathic pancreatitis.en_US
dc.languageengen_US
dc.publisherMassachusetts Medical Society. The Journal's web site is located at http://content.nejm.org/en_US
dc.relation.ispartofNew England Journal of Medicineen_US
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAgeden_US
dc.subject.meshBile - Chemistryen_US
dc.subject.meshBilirubin - Analysisen_US
dc.subject.meshCholecystectomyen_US
dc.subject.meshCholelithiasis - Complicationsen_US
dc.subject.meshCholestanol - Analysisen_US
dc.subject.meshCholesterol - Analysisen_US
dc.subject.meshCrystallizationen_US
dc.subject.meshDrug Combinationsen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshGallbladder - Ultrasonographyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshPancreatitis - Etiology - Surgery - Ultrasonographyen_US
dc.subject.meshRecurrenceen_US
dc.subject.meshSphincterotomy, Endoscopicen_US
dc.titleBiliary sludge as a cause of acute pancreatitisen_US
dc.typeArticleen_US
dc.identifier.emailLee, SP: sumlee@hku.hken_US
dc.identifier.authorityLee, SP=rp01351en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1056/NEJM199202273260902-
dc.identifier.pmid1734248-
dc.identifier.scopuseid_2-s2.0-0026595670en_US
dc.identifier.volume326en_US
dc.identifier.issue9en_US
dc.identifier.spage589en_US
dc.identifier.epage593en_US
dc.identifier.isiWOS:A1992HF63300002-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridLee, SP=7601417497en_US
dc.identifier.scopusauthoridNicholls, JF=7201464908en_US
dc.identifier.scopusauthoridPark, HZ=7601570519en_US

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