# 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 · 27 cited statements

## Episodes
### Nutritional Management
- [Enteral Nutrition in Pancreatitis: 2018 Pediatric Surgery Practice Gap #9](https://qa.library.globalcastmd.com/watch/enteral-nutrition-in-pancreatitis-2018-pediatric-surgery-practice-gap-9-1451) — video · 1:00 · [machine version](https://qa.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://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351) — video · 16:15 · [machine version](https://qa.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://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797) — podcast · 18:12 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797.md)

## Chapters
- [0:00](https://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=0) Introduction and case presentation (Ep 3)
- [1:32](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=92) Index admission versus delayed cholecystectomy (Ep 3)
- [4:49](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=289) Predicting common bile duct stones (Ep 3)
- [8:31](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=511) Approach to choledocholithiasis: ERCP versus laparoscopic exploration (Ep 3)
- [13:03](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=783) Indocyanine green fluorescent cholangiography (Ep 3)
- [16:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=985) Summary and closing (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Early enteral feedings when not associated with vomiting decrease morbidity, infectious risk, and mortality in pancreatitis" — Ray (clinical) [Ep 2 · 0:17](https://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.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://qa.library.globalcastmd.com/watch/enteral-nutritional-support-for-pancreatitis-practice-gap-discussion-at-351?t=931)
- "Chile has the highest rate of cholelithiasis globally" — Jose Campos (epidemiological) [Ep 3 · 1:07](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=67)
- "In a multi-center study of 167 early cholecystectomy patients versus 79 delayed, early cholecystectomy had 2% recurrence of pancreatitis compared to 22% in delayed surgery" — Cecilia Gigena (host_summary) [Ep 3 · 3:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=191)
- "When cholecystectomy was delayed more than 6 weeks after gallstone pancreatitis, recurrence rate increased to 60%" — Cecilia Gigena (host_summary) [Ep 3 · 3:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=216)
- "Even in patients with no stones remaining, 2% will get recurrent pancreatitis from the initial insult" — Todd Ponsky (clinical) [Ep 3 · 3:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=224)
- "Patients who underwent early cholecystectomy did not have more biliary complications than delayed surgery patients" — Cecilia Gigena (host_summary) [Ep 3 · 4:27](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=267)
- "When patients present with gallstone pancreatitis, most pain and elevated enzymes occur as the stone is passing, and symptoms often resolve overnight as the stone passes" — Todd Ponsky (clinical) [Ep 3 · 5:01](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=301)
- "If laboratory values normalize after gallstone pancreatitis, ERCP is not indicated, but intraoperative cholangiogram should be performed to check for additional stones" — Todd Ponsky (clinical) [Ep 3 · 5:36](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=336)
- "A Western Pediatric Surgery Research Consortium machine learning algorithm based on 1600 patients from 10 centers (2016-2019) can predict common bile duct stones using nine clinical factors, with 20% of patients having CBD stones" — Em Gootee (host_summary) [Ep 3 · 6:26](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=386)
- "The machine learning algorithm for predicting CBD stones has a negative predictive value of 98%, meaning only 2% chance of missing stones when algorithm predicts low risk" — Jose Campos (host_summary) [Ep 3 · 7:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=431)
- "The previous algorithm for predicting CBD stones was based on 300-400 patients, compared to 1600 in the new algorithm" — Em Gootee (host_summary) [Ep 3 · 7:33](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=453)
- "For patients with impacted stone, rising lipase, and worsening jaundice, ERCP is preferred because surgeon confidence in retrieving impacted stones intraoperatively is lower" — Todd Ponsky (opinion) [Ep 3 · 8:58](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=538)
- "In a multi-center study of 252 patients with choledocholithiasis, 156 underwent OR-first approach (laparoscopic cholecystectomy with intraoperative cholangiogram) and 96 underwent ERCP-first approach" — Cecilia Gigena (host_summary) [Ep 3 · 11:27](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=687)
- "Patients who underwent intraoperative cholangiogram first had fewer complications and shorter length of stay than ERCP-first patients, and 86% needed only the surgery without subsequent ERCP" — Cecilia Gigena (host_summary) [Ep 3 · 11:41](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=701)
- "The laparoscopic common bile duct exploration study included 4 centers with a broad range of surgeons, demonstrating feasibility beyond single expert centers" — Jose Campos (host_summary) [Ep 3 · 11:56](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=716)
- "Of patients who had ERCP after failed laparoscopic CBD exploration (14% of OR-first group), outcomes were good without increased bile duct leak or complications" — Jose Campos (host_summary) [Ep 3 · 12:15](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=735)
- "In the stepwise laparoscopic CBD exploration approach, 84% of patients had stones cleared with saline flush through a ureteral catheter alone" — Jose Campos (host_summary) [Ep 3 · 12:30](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=750)
- "In a study of 173 laparoscopic cholecystectomies over 10 years (2013-2023), 83 used standard technique and 90 used ICG fluorescence" — Em Gootee (host_summary) [Ep 3 · 13:34](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=814)
- "The ICG study showed perioperative complication rate of 12% in standard technique versus 0% with ICG, with significantly shorter operative times and better biliary visualization in the ICG group" — Em Gootee (host_summary) [Ep 3 · 13:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=834)
- "The ICG study compared different time periods rather than contemporaneous groups, confounding the comparison with improvements in surgical skill and instruments over time" — Jose Campos (opinion) [Ep 3 · 14:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=865)
- "The ICG study combined all complications without separately reporting common bile duct injuries, and bleeding complications are unlikely attributable to presence or absence of ICG" — Jose Campos (opinion) [Ep 3 · 14:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=883)
- "A complication rate of zero in any surgical series raises methodological concerns" — Jose Campos (opinion) [Ep 3 · 14:57](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=897)
- "ICG can be administered intravenously, eliminating the need for instrumentation required by traditional intraoperative cholangiogram" — Todd Ponsky (clinical) [Ep 3 · 15:21](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=921)
- "The ICG study compared ICG to simple visualization without any imaging technique, not to intraoperative cholangiogram, making improved visualization an expected rather than surprising finding" — Jose Campos (opinion) [Ep 3 · 15:38](https://qa.library.globalcastmd.com/watch/case-based-journal-review-cholelithiasis-2024-8797?t=938)

## Changelog
- Sep 7: 3 items added automatically

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