Purpose: Many studies have suggested multiple etiologies for the postcholecystectomy syndrome. However, the question was never raised whether we are removing way too many normal gall bladders based on an imperfect test (the GB Ejection Fraction (GB EF) on the Hepato-Biliary Scan). Th e Objective of this study was to revise the current standard of 35% as the cut-off for recommending a cholecystectomy. Methods: Between 2008 and 2011, the electronic medical records of 337 patients who underwent cholecystectomy at a community hospital were reviewed, and the data was extracted. One hundred patients were excluded because they had stones on the GB path reports. Only patients with no stones were included in this study. Two hundred thirty patients were included, 145 females, and 85 males. Seven patients were excluded because they were younger than 18 years of age. Results: Th e mean GB EF was 28% with a range from 0% to 86%. Th ere were 145 females and 85 males, with an age range from 18 to 87 years of age. Th e ER visits for those patients were recorded for one year following their cholecystectomy. One hundred sixty-nine patients were still symptomatic following their cholecystectomy (73%). Patients with higher EF and no stones had more frequent ER visits for GI related complaints and abdominal pain (more than four visits in one year) than patients with lower EF (one or less ER visit in one year). Female patients tend to do worse following cholecystectomy than their male counterparts, particularly younger females. Conclusion: In absence of symptomatic gall stones, the GB EF should not be used as a sole indication for cholecystectomy. If it is used, it should be documented to be less than 10% on two diff erent occasions done in the outpatient setting, six weeks apart.Purpose: Th e role and timing of ERCP in acute gallstone pancreatitis (AGP) remains controversial. To assess the eff ect of early routine ERCP strategy versus early conservative management strategy in patients with AGP. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the clinical eff ectiveness and safety of early routine ERCP strategy compared to early conservative management strategy. We searched CENTRAL, MEDLINE, EMBASE and LILACS databases and major conference proceedings up to January 2012 with no language restriction. RCTs comparing early routine ERCP strategy versus early conservative management with or without selective use of ERCP strategy in patients with AGP were included. Study selection, data extraction and methodological quality assessment using the risk of bias instrument were conducted independently by two authors. Primary outcome was mortality. Secondary outcomes included local and systemic complications as defi ned by the Atlanta Classifi cation and ERCP related complications. Revman 5.1 was used to calculate pooled risk ratios (RR) with 95% confi dence intervals (Mandel-Haenszel method; random eff ects model).Heterogeneity was assessed by Chi 2 test (P<0.10) and I 2 test (>50%). To explore possible sou...
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