# Gallstone Pancreatitis — GCMD Library living collection

Everything in the library about gallstone pancreatitis — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 43 cited statements

## Episodes
### Nutritional Management
- [Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451) — video · 1:00 · [machine version](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451.md)

### Evidence & Research
- [Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351) — video · 16:15 · [machine version](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351.md)

### Case-Based Learning
- [Case-Based Journal Review: Cholelithiasis 2024](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797) — podcast · 18:12 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=0) Introduction and Transfusion Policy Discussion (Ep 1)
- [1:40](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=100) Case Presentation: Acute Pancreatitis Nutrition Question (Ep 1)
- [6:00](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=360) Evidence for Early Enteral Feeding in Pancreatitis (Ep 1)
- [8:35](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=515) Management of Gallstone Pancreatitis: ERCP vs Operative Approach (Ep 1)
- [14:41](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=881) Timing of Cholecystectomy and Summary (Ep 1)
- [0:04](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=4) Practice Gap #9: Enteral Nutrition in Pancreatitis (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=0) Introduction and Case Presentation: Timing of Cholecystectomy (Ep 3)
- [4:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=290) Predicting Choledocholithiasis: Machine Learning Algorithm (Ep 3)
- [7:50](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=470) Management of Choledocholithiasis: ERCP vs. Laparoscopic Exploration (Ep 3)
- [13:00](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=780) Role of ICG Fluorescent Cholangiography and Summary (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Chile has the highest rate of cholelithiasis globally" — Jose Campos (epidemiological) [Ep 3 · 1:07](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=67)
- "Historical threshold for 'cool-off period' before cholecystectomy was 7-10 days in general surgery, later reduced to 2-3 days in pediatric surgery" — Jose Campos (clinical) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=113)
- "In multi-center study of 246 patients (167 early, 79 delayed cholecystectomy), early cholecystectomy during index admission had 2% pancreatitis recurrence vs. 22% in delayed approach" — Cecilia Gigena (clinical) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=191)
- "When cholecystectomy was delayed more than 6 weeks, pancreatitis recurrence rate increased to 60%" — Cecilia Gigena (clinical) [Ep 3 · 3:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=216)
- "Even with no stones remaining, 2% baseline recurrence rate of pancreatitis exists from initial insult" — Todd Ponsky (clinical) [Ep 3 · 3:44](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=224)
- "Early cholecystectomy did not result in increased biliary complications compared to delayed approach" — Cecilia Gigena (clinical) [Ep 3 · 4:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=267)
- "In gallstone pancreatitis, pain and elevated enzymes typically occur as the stone is passing, often resolving overnight" — Todd Ponsky (clinical) [Ep 3 · 5:01](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=301)
- "If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated; intraoperative cholangiogram is sufficient to check for retained stones" — Todd Ponsky (clinical) [Ep 3 · 5:36](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=336)
- "Western Pediatric Surgery Research Consortium machine learning algorithm for predicting CBD stones was developed from 1600 patients across 10 centers (2016-2019), with 20% having CBD stones" (clinical) [Ep 3 · 6:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=386)
- "The predictive algorithm has a 98% negative predictive value for common bile duct stones" — Jose Campos (clinical) [Ep 3 · 7:11](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=431)
- "Using the algorithm, risk of encountering unexpected CBD stone intraoperatively is only 2%" — Jose Campos (clinical) [Ep 3 · 7:22](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=442)
- "For patients with impacted CBD stone, worsening lipase, and increasing jaundice, ERCP is preferred because surgeon skill at retrieving impacted stones may be limited" — Todd Ponsky (opinion) [Ep 3 · 8:58](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=538)
- "Stones identified on ultrasound (non-impacted) are more amenable to intraoperative laparoscopic removal" — Todd Ponsky (clinical) [Ep 3 · 9:17](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=557)
- "In multi-center study of 252 patients (156 OR-first, 96 ERCP-first), OR-first approach with intraoperative cholangiogram had fewer complications and shorter length of stay" — Cecilia Gigena (clinical) [Ep 3 · 11:27](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=687)
- "86% of patients in OR-first group required only the initial surgery without subsequent ERCP" — Cecilia Gigena (clinical) [Ep 3 · 11:41](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=701)
- "The multi-center laparoscopic CBD exploration study included 4 centers with a broad range of surgeon expertise, demonstrating feasibility beyond single expert centers" — Jose Campos (clinical) [Ep 3 · 11:56](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=716)
- "14% of patients who underwent laparoscopic CBD exploration required subsequent ERCP without increased complications such as bile duct leak" — Jose Campos (clinical) [Ep 3 · 12:15](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=735)
- "In stepwise laparoscopic CBD exploration approach, 84% of CBD stones cleared with simple saline flush through ureteral catheter" — Jose Campos (clinical) [Ep 3 · 12:30](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=750)
- "ICG cholangiography study (2013-2023, 173 patients: 83 standard, 90 ICG) showed perioperative complication rate of 12% in standard technique vs. 0% with ICG" (clinical) [Ep 3 · 13:34](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=814)
- "ICG technique showed significantly shorter operative time, cystic duct isolation time, clipping time, and gallbladder removal time compared to standard technique" (clinical) [Ep 3 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "Complete biliary tree visualization rate was significantly higher with ICG compared to standard technique" (clinical) [Ep 3 · 14:03](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=843)
- "ICG study compared different time periods (2013-2023) rather than concurrent randomized groups, introducing confounding from improved surgical technique and instrumentation over time" — Jose Campos (opinion) [Ep 3 · 14:25](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=865)
- "ICG study grouped all complications together without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence/absence of ICG" — Jose Campos (opinion) [Ep 3 · 14:43](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=883)
- "Zero complications in ICG group raises methodological concerns about reporting accuracy" — Jose Campos (opinion) [Ep 3 · 14:57](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=897)
- "ICG study compared ICG to simple visualization without intraoperative cholangiogram, not ICG vs. intraoperative cholangiogram" — Jose Campos (opinion) [Ep 3 · 15:38](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=938)
- "Intravenous ICG administration eliminates need for instrumentation of the biliary tree, which is a significant advantage" — Todd Ponsky (clinical) [Ep 3 · 15:26](https://library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=926)
- "Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis" — Ray (clinical) [Ep 2 · 0:17](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=17)
- "Nasogastric feeds are equally as tolerated as nasojejunal feeds in pancreatitis" — Ray (clinical) [Ep 2 · 0:26](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Earlier surgical intervention is recommended for gallstone pancreatitis" — Ray (guideline) [Ep 2 · 0:26](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=26)
- "Traditional teaching was to wait many days for amylase and lipase to normalize and for abdominal pain to resolve before starting feeds in pancreatitis" (opinion) [Ep 2 · 0:35](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=35)
- "Enteral feeding can be provided even in the presence of infected pancreatic phlegmon" (clinical) [Ep 2 · 0:49](https://library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451?t=49)
- "A restrictive transfusion policy with hemoglobin threshold of 7 (rather than 9 or 10) will have no difference in mortality." (host_summary) [Ep 1 · 1:03](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=63)
- "RBC transfusions may confer increased risk of DVT in pediatric patients (not NICU scenario), per JAMA Surgery paper." — Chuck (host_summary) [Ep 1 · 1:20](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=80)
- "Glutamine and arginine have been tried as amino acid nutritional supplements to stabilize gut mucosa or promote nutrition, but there is not a lot of evidence that they actually work." (clinical) [Ep 1 · 3:30](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=210)
- "In adults, evidence strongly recommends early feeding (24 to 48 hours) with enteral feedings for acute pancreatitis." — Chuck (host_summary) [Ep 1 · 6:16](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=376)
- "The route of enteral feeding (nasogastric vs nasojejunal) does not seem to make any difference in pancreatitis management." — Chuck (host_summary) [Ep 1 · 6:28](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=388)
- "In adults, enteral feeding in pancreatitis reduces morbidity, infectious complications, and mortality, particularly with severe pancreatitis but even in mild to moderate cases, based on meta-analyses and multiple studies." — Chuck (host_summary) [Ep 1 · 6:44](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=404)
- "There is no benefit to supplemental administration of specific amino acids (glutamine, arginine) in pancreatitis cases." — Chuck (host_summary) [Ep 1 · 7:05](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=425)
- "Most studies in children regarding enteral feeding in pancreatitis are fairly small and retrospective, but there is good reason to assume the same beneficial effects would occur as in adults." — Chuck (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=437)
- "The myth from surgical training was that feeding would stimulate hormones and the pancreas, but that is not the case." — Craig (clinical) [Ep 1 · 7:28](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=448)
- "Studies specifically tracked pain and lipase levels and found they did not particularly correlate with enteral feeding; feeding did not cause these parameters to increase." — Chuck (host_summary) [Ep 1 · 8:09](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=489)
- "For gallstone pancreatitis with persistent obstruction, if you have an ERCP endoscopist at your institution, do laparoscopic cholecystectomy first, and if you cannot get the stone out, then remove it by ERCP postoperatively (the adult approach)." — Ron (clinical) [Ep 1 · 9:38](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=578)
- "Transcystic stone extraction techniques include flushing the stone out, pushing it back with a Fogarty catheter, or using a basket." — Ron (clinical) [Ep 1 · 9:58](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=598)
- "One study showed that operative management of gallstone pancreatitis cut down length of stay by about 2 days compared to waiting for ERCP." — Ron (clinical) [Ep 1 · 10:30](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=630)
- "If the common bile duct is dilated, the cystic duct is usually dilated, allowing placement of a choledochoscope through the cystic duct to basket the stone." — Ron (clinical) [Ep 1 · 11:31](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=691)
- "Using a basket with fluoroscopy during intraoperative cholangiogram is successful about 90% of the time for stone extraction." — Mark (clinical) [Ep 1 · 11:58](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=718)
- "The traditional teaching was to let pancreatitis settle down with an interval before cholecystectomy, but experience shows you probably do not gain with that delay; in fact, if you delay to an intermediate timepoint, you may be in a worse spot." — Craig (clinical) [Ep 1 · 12:30](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=750)
- "SAGES is now recommending a paradigm change: even for a stuck stone in gallstone pancreatitis, try laparoscopic cholecystectomy with intraoperative cholangiogram first, then send for ERCP if needed; pre-operative ERCP is falling by the wayside." (host_summary) [Ep 1 · 12:54](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=774)
- "By the time ERCP is set up for gallstone pancreatitis, the stone has often already passed, which is why there are so many negative ERCPs." (clinical) [Ep 1 · 13:23](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=803)
- "For gallstone pancreatitis after stone passage, cholecystectomy should be performed early in the same hospitalization (within 24-48 hours if clinically improving), even if pancreatitis has not completely resolved." — Chuck (clinical) [Ep 1 · 13:42](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=822)
- "If cholecystectomy is delayed until a month after gallstone pancreatitis, the pancreatitis can recur." (host_summary) [Ep 1 · 14:41](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=881)
- "Literature shows that amylase and lipase are not good predictors of severity of pancreatitis." — Ron (host_summary) [Ep 1 · 15:18](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=918)
- "There is no advantage of nasojejunal versus nasogastric feeds in pancreatitis unless the patient is vomiting and cannot tolerate nasogastric feeds." — Chuck (clinical) [Ep 1 · 15:31](https://library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=931)

## Changelog
- Sep 7: 3 items added automatically

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