Matthew L. Vincent, MBBS, MS, Manik Aggarwal, MBBS, Darrell S.. Pardi, MD, MS, Vinay Chandrasekhara, MD Mayo Clinic, Rochester, MN
Introduction: Endoscopic retrograde cholangio-pancreatography (ERCP) guided transpapillary gallbladder drainage (ET-GBD) has emerged as an effective alternative for management of acute cholecystitis (AC) in non-operable candidates. Delayed acute pancreatitis (AP) has not been described after ET-GBD with double pigtail plastic stents.
Case Description/Methods: A retrospective review of patients undergoing ET-GBD identified 3 cases of AP occurring >1 week after transpapillary (TP) stent placement or exchange.
Case 1:
An 88-year-old female with aortic stenosis underwent ET-GBD for AC. Six weeks later, she developed sudden onset epigastric pain. Labs showed a lipase >3000 U/L. CT scan showed edema in the pancreatic-duodenal groove. Repeat ERCP was performed to replace the plastic stent. Two weeks later, she had another episode of epigastric pain with a lipase >3000 U/L. CT scan was consistent with AP. She passed away from complications shortly after admission.
Case 2:
A 62-year-old female with cryptogenic cirrhosis and AC managed with ET-GBD 3 years prior was found to have gallbladder dilation on screening ultrasonography for hepatocellular carcinoma. Repeat ERCP exchanged the stent. Two weeks later, she presented with acute epigastric pain and CT findings consistent with AP. She was managed with intravenous hydration and discharged in stable condition.
Case 3:
A 64-year-old female with rheumatic heart disease with mechanical aortic, tricuspid, and mitral valves was admitted with gallstone pancreatitis. ET-GBD was performed for prevention of cholecystitis given poor operative candidacy. Three weeks later, she returned to hospital with severe epigastric pain. Abdominal CT scan showed peripancreatic inflammation and lipase was 293 U/L (ULN 67U/L). An open cholecystectomy was performed with removal of the transpapillary stent. She had no further episodes of pancreatitis.
Discussion: Delayed acute pancreatitis may represent a rare and previously unknown adverse event of ET-GBD.
Disclosures:
Matthew Vincent indicated no relevant financial relationships.
Manik Aggarwal indicated no relevant financial relationships.
Matthew L. Vincent, MBBS, MS, Manik Aggarwal, MBBS, Darrell S.. Pardi, MD, MS, Vinay Chandrasekhara, MD. P2304 - Delayed Acute Pancreatitis After Transpapillary Gallbladder Drainage With Plastic Stents, A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
