What is Role of Cholecystectomy in Idiopathic Pancreatitis

Acute pancreatitis is inflammation of the pancreas along with peripancreatic tisssue. It has got high morbidity & Mortality. The occurence of two or more episodes of acute pancreatitis is recurrent acute pancreatitis. It is classified as idiopathic RAP when we cannot found any cause after a bundle of investigations. The incidence is 10-30%

The initial evaluation includes drugs history & family history of pancreatitis, Lab tests (Serum calcium,LFT & triglyceride level), USG abdomen, CECT Abdomen and MRCP

The relapse rate after first episodes varies from 14% to 24% in different studies. The rare causes include sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), annular pancreas,a choledochocele, hereditary pancraetitis, Biliary sludge

Various tests have been described in literature to investigate further which include microscopic bile examination (MBE), genetic testing, ERCP with sphincter of oddi manometery, MRCP-S ( Secretin enhanced MRCP), EUS. Among all these tests EUS has emerged as diagnostic tool of choice for these patients

Various studies says EUS identified additional diagnostic information in most of these patients . The most common etiology found is microlithiasis missed on Ultrasound & MRI.It should be done after a single episode of pancreatitis after 4 weeks when the inflammation has settled down and chances of false positive diagnosis of biliary pancreatitis is also reduced as during initial phase of pancreatitis patient is in fasting stage which can also induce GB sludge

Role of prophylactic cholecystectomy is controversial, Yes if EUS after one month shows biliary sludge or microlithiasis. As the incidence of biliary sludge is more than 60% and EUS is not readily available and cholecystectomy is safe procedure, Patient can be counselled and may be advised cholecystectomy to prevent further epiosdes of pancreatitis which sometimes may be life-threatening