{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T15:49:56Z","timestamp":1786549796226,"version":"build-2736575974"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"\n Importance<\/jats:title>\n Same-admission cholecystectomy is recommended by guidelines for mild gallstone-related acute pancreatitis, yet surgery is often deferred. Endoscopic retrograde cholangiopancreatography (ERCP) is often used as an interim strategy, but its effectiveness compared with cholecystectomy is uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare cholecystectomy, ERCP only, and no intervention in association with recurrent acute pancreatitis and other gallstone-related complications, accounting for death as a competing event.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This population-based cohort study used nationwide Swedish registries (2006-2019). Adults with first episodes of gallstone-related acute pancreatitis and a length of hospital stay 10 days or less were included. Follow-up began on the day after discharge. Fine-Gray subdistribution hazard models were applied in prespecified time windows (\u22647, 8-14, 15-30, 31-90, 91-365, and &amp;gt;365 days), adjusted for age, sex, socioeconomic factors, and comorbidities. These data were analyzed from September 2025 through January 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Index-admission cholecystectomy, ERCP only, or no intervention; elective postdischarge cholecystectomy was modeled as a time-varying covariate.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was recurrent acute pancreatitis. The secondary outcome was other gallstone-related complications (acute cholecystitis and\/or choledocholithiasis).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 9593 patients (median [IQR], age 61 [44-75] years; 60.3% female and 39.7% male), 28.7% underwent cholecystectomy, 16.9% ERCP only, and 54.4% no intervention during index hospital stay. Recurrence of acute pancreatitis in the 3 groups was 3.4%, 4.9%, and 17.5%, respectively. Similar differences were seen in adjusted models (overall subdistribution hazard ratio [sHR] for ERCP only, 1.40; 95% CI, 1.02-1.92 and for no intervention, 6.06; 95% CI, 4.85-7.56 compared with cholecystectomy). The risk of recurrence peaked 8 to 14 days after discharge among patients treated with ERCP only; beyond 15 days, there was no evidence of higher recurrence after ERCP only compared with cholecystectomy. Other gallstone-related complications occurred in 1.6% in the cholecystectomy group, 19.9% in the ERCP only group, and 16.3% in the no intervention group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, same-admission cholecystectomy was associated with the lowest recurrence in acute pancreatitis and the lowest rate of other gallstone-related complications. ERCP only was associated with low long-term risk of recurrence but other gallstone-related complications remained common. These findings support prioritizing same-admission cholecystectomy in all individuals with acute gallstone-related pancreatitis, provided they are fit for surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.2168","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:31:17Z","timestamp":1782315077000},"page":"832","source":"Crossref","is-referenced-by-count":0,"title":["Cholecystectomy vs Endoscopic Retrograde Cholangiopancreatography or No Intervention After Gallstone-Related Acute Pancreatitis"],"prefix":"10.1001","volume":"161","author":[{"given":"Daniel","family":"Selin","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Center for Clinical Research S\u00f6rmland, Uppsala University, 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Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Lindblad","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Holmberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Surgery and Oncology, Capio St G\u00f6ran Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Sadr-Azodi","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Department of Surgery and Oncology, Capio St G\u00f6ran Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"soi260035r1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1053\/j.gastro.2021.09.043","article-title":"Global incidence of acute pancreatitis is increasing over time: a systematic review and 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