Gallstones are the most frequent cause of acute pancreatitis. According to the American Gastroenterology Association (see ref below), gallstone related acute pancreatitis represent 35-40% of the cases. Interestingly, only 5% of the patients with gallstones will develop pancreatitis.
Several studies have been conducted to investigate the optimal timing for cholecystectomy in patients with biliary pancreatitis. A recent Cochrane review (which summarises and aggregates the evidence from all the studies) has concluded the folowing:
There is no evidence of increased risk of complications after early
laparoscopic cholecystectomy. Early laparoscopic cholecystectomy may
shorten the total hospital stay in people with mild acute
pancreatitis. If appropriate facilities and expertise are available,
early laparoscopic cholecystectomy appears preferable to delayed
laparoscopic cholecystectomy in those with mild acute pancreatitis.
There is currently no evidence to support or refute early laparoscopic
cholecystectomy for people with severe acute pancreatitis. Further
randomised controlled trials at low risk of bias are necessary in
people with mild acute pancreatitis and severe acute pancreatitis.
But this is not an "upfront" procedure. The etiology of acute pancreatitis needs to be determined first. The AGA has provided some recommendations on the steps which should be undertaken to determine the etiologies for pancreatitis (you can find them in the reference below) such as:
- History taking should focus on possible risk factors for pancreatitis (previous symptoms, hypertriglyceridemia, the 4 F (female, fat, forty fertile) as RF for choleliathiasis, drug and alcool use, autoimmmune diseases)
- Appropriate lab and clinical examination
- Abdominal ultrasound (to detect possible cholelithiasis or choledocholithiasis)
- EUS (endoscopic ultrasound) or ERCP (endoscopic retrograde cholangiopancreatography): if cause unclear or suspicion of tumor or if high suspicion for cholelithiasis but not visualised in abdominal US
Gurusamy KS. Early versus delayed laparoscopic cholecystectomy for acute gallstone pancreatitis.Cochrane Database Syst Rev. 2013 Sep 2;(9):CD010326. doi: 10.1002/14651858.CD010326.pub2.
Forsmark. AGA Institute Technical Review on Acute Pancreatitis. Gastroenterology. May 2007Volume 132, Issue 5, Pages 2022–2044