Lower rate of pancreatobiliary complications after sludge and microlithiasis pancreatitis compared to gallstone pancreatitis

Abstract

Background and Aims: Cholecystectomy is recommended to prevent recurrence of biliary pancreatitis, but supporting evidence is limited for sludge- and microlithiasis-induced acute pancreatitis (AP). This study aimed to compare relapse patterns and risk factors between patients with sludge/microlithiasis-induced AP and gallstone-induced AP. Methods: This analysis included 789 patients from the international, multicenter Relapstone cohort (Spain: 16 centers; Mexico: 2 centers), hospitalized between January 2018 and April 2020 with first-time biliary AP and no cholecystectomy during admission. Patients with sludge/microlithiasis-induced AP (n = 274) were compared to those with gallstone-induced AP (n = 515) regarding pancreatobiliary complications. Multivariate analysis was used to assess relapse risk factors. Results: Pancreatobiliary complications occurred in 41.7 % of the gallstone cohort versus 32.1 % in the sludge/microlithiasis cohort (p = 0.01). Correspondingly, the gallstone AP cohort showed a significantly lower complication-free survival rate (log-rank p = 0.0022; median follow-up: 6.1 vs. 8.1 months). In multivariate analysis, older age in the gallstone group was significantly associated with lower relapse risk (HR = 0.54, 95 % CI: 0.39–0.74). Conclusion: This multicenter study reveals distinct differences in relapse risk between gallstone- and sludge/microlithiasis-induced AP, with gallstone AP showing a higher rate of complications in the absence of cholecystectomy.