Occult microlithiasis in 'idiopathic' acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy.

摘要: Gallstone pancreatitis is usually related to small stones, which may not be detected by conventional cholecystographic techniques. In the current study, it was hypothesized that some patients with acute of unknown cause could harbor occult microstones in gallbladder. Therefore, evidence sought prospectively missed gallstones biliary drainage and microscopic examination centrifuged duodenal bile 51 recovering from an attack pancreatitis, including 24 relapsing episodes. Clusters cholesterol monohydrate crystals, calcium bilirubinate granules, and/or CaCO3 microspheroliths were found 67% patients. Biliary showed no abnormal findings 12 convalescing a bout known alcoholic pancreatitis. Examination gallbladder at cholecystectomy serial ultrasonography for up months 73% unexplained had sludge or microlithiasis; prior finding crystal/solid markers predicted their existence both sensitivity specificity 86% predictive value 94%. The probability harboring also associated age (P = 0.004), recurrent 0.024), altered liver function tests results during index episode 0.003). 13 crystals bile, ursodeoxycholic acid (10 mg.kg-1.day-1) eliminated microlithiasis within 3-6 months, subsequent maintenance treatment daily dose 300 mg prevented gallstone recurrence further attacks over mean follow-up period 44 months. Cholecystectomy gallstone-associated relapses 17 18 followed postoperative 36 This study provides firm showing most idiopathic disease gallstones, as evidenced development macroscopic stones prevention either cholelitholytic acid. Occult should strongly suspected when occurs manner aged test results. microscopy provide simple means uncovering them institute appropriate therapy prevent attacks.