Gallstone Pancreatitis
Everything in the library about gallstone pancreatitis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Nutritional Management
1 item
Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9
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Drs Todd Ponsky, Alex Casar, Alex Gibbons and Rae Hanke review Practice Gap #9 from 2018, as identified by APSA's Professional Development Committee.
video1:00 · Jun 2019
Evidence & Research
1 item
Enteral Nutritional Support For Pancreatitis: Practice Gap discussion at...
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss enteral nutritional support for pancreatitis, focusing on early enteral feedi
video16:15 · Sep 2018
Case-Based Learning
1 item
Case-Based Journal Review: Cholelithiasis 2024
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It is already public knowledge that thousands of articles on different pathologies are published every day and that it is very difficult to follow them.
In this format we bring you a different way of knowing what is the most up-to-date o
podcast18:12 · Jul 2024
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Case-Based Journal Review: Cholelithiasis 2024
Chile has the highest rate of cholelithiasis globally
epidemiologicalJose Campos1:07 ↗
Historical threshold for 'cool-off period' before cholecystectomy was 7-10 days in general surgery, later reduced to 2-3 days in pediatric surgery
clinicalJose Campos1:53 ↗
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
clinicalCecilia Gigena3:11 ↗
When cholecystectomy was delayed more than 6 weeks, pancreatitis recurrence rate increased to 60%
clinicalCecilia Gigena3:36 ↗
Even with no stones remaining, 2% baseline recurrence rate of pancreatitis exists from initial insult
clinicalTodd Ponsky3:44 ↗
Early cholecystectomy did not result in increased biliary complications compared to delayed approach
clinicalCecilia Gigena4:27 ↗
In gallstone pancreatitis, pain and elevated enzymes typically occur as the stone is passing, often resolving overnight
clinicalTodd Ponsky5:01 ↗
If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated; intraoperative cholangiogram is sufficient to check for retained stones
clinicalTodd Ponsky5:36 ↗
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
clinical6:26 ↗
The predictive algorithm has a 98% negative predictive value for common bile duct stones
clinicalJose Campos7:11 ↗
Using the algorithm, risk of encountering unexpected CBD stone intraoperatively is only 2%
clinicalJose Campos7:22 ↗
For patients with impacted CBD stone, worsening lipase, and increasing jaundice, ERCP is preferred because surgeon skill at retrieving impacted stones may be limited
opinionTodd Ponsky8:58 ↗
Stones identified on ultrasound (non-impacted) are more amenable to intraoperative laparoscopic removal
clinicalTodd Ponsky9:17 ↗
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
clinicalCecilia Gigena11:27 ↗
86% of patients in OR-first group required only the initial surgery without subsequent ERCP
clinicalCecilia Gigena11:41 ↗
The multi-center laparoscopic CBD exploration study included 4 centers with a broad range of surgeon expertise, demonstrating feasibility beyond single expert centers
clinicalJose Campos11:56 ↗
14% of patients who underwent laparoscopic CBD exploration required subsequent ERCP without increased complications such as bile duct leak
clinicalJose Campos12:15 ↗
In stepwise laparoscopic CBD exploration approach, 84% of CBD stones cleared with simple saline flush through ureteral catheter
clinicalJose Campos12:30 ↗
ICG cholangiography study (2013-2023, 173 patients: 83 standard, 90 ICG) showed perioperative complication rate of 12% in standard technique vs. 0% with ICG
clinical13:34 ↗
ICG technique showed significantly shorter operative time, cystic duct isolation time, clipping time, and gallbladder removal time compared to standard technique
clinical14:03 ↗
Complete biliary tree visualization rate was significantly higher with ICG compared to standard technique
clinical14:03 ↗
ICG study compared different time periods (2013-2023) rather than concurrent randomized groups, introducing confounding from improved surgical technique and instrumentation over time
opinionJose Campos14:25 ↗
ICG study grouped all complications together without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence/absence of ICG
opinionJose Campos14:43 ↗
Zero complications in ICG group raises methodological concerns about reporting accuracy
opinionJose Campos14:57 ↗
ICG study compared ICG to simple visualization without intraoperative cholangiogram, not ICG vs. intraoperative cholangiogram
opinionJose Campos15:38 ↗
Intravenous ICG administration eliminates need for instrumentation of the biliary tree, which is a significant advantage
clinicalTodd Ponsky15:26 ↗
Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9
Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis
clinicalRay0:17 ↗
Nasogastric feeds are equally as tolerated as nasojejunal feeds in pancreatitis
clinicalRay0:26 ↗
Earlier surgical intervention is recommended for gallstone pancreatitis
guidelineRay0:26 ↗
Traditional teaching was to wait many days for amylase and lipase to normalize and for abdominal pain to resolve before starting feeds in pancreatitis
opinion0:35 ↗
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