Effect of Endoscopic Sphincterotomy on Bile Lithogenicity in Patients with Gallbladder In Situ

Caroli-Bosc, François-Xavier; Montet, Jean-Claude; Salmon, L.; Demarquay, J. F.; Dumas, R; Montet, Anne-Marie; Bernard, J; Delmont, J

doi:10.1055/s-1999-49

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…This effect arises mainly from increased cholesterol nucleation time and a decreased cholesterol saturation index. A consequence of this effect could be a reduced risk of cholesterol lithiasis [8,11]. These findings are in good agreement with the results of studies showing lower rates of cholecystitis in patients with ES [22,27,34,36,42] than in those without sphincterotomy and gallbladder in situ [15].…”

Section: Discussionsupporting

confidence: 88%

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

et al. 2004

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Section: Discussionsupporting

confidence: 88%

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

et al. 2004

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“…After EST, GB contractility is enhanced and bile lithogenicity decreased by prolonged nucleation time and reduced cholesterol saturation index 13 ) , so newly developed GB calculi are minimal. Furthermore, GB stones that have never caused symptoms are unlikely to cause symptoms in the future 6 , 14 ) . Stone composition and pathogenesis differ between GB calculi and bile duct stones 13 ) , so in cases of cleared bile duct stones and resolved symptoms, GB calculi are asymptomatic 15 , 16 ) .…”

Section: Discussionmentioning

confidence: 99%

“…After an initial attack of acute biliary pancreatitis, early cholecystectomy is usually recommended to prevent further episodes 7 ) . Recently, many studies have shown that the chance of recurrent pancreatitis is low, and that attacks are often mild 14 ) . In this study, only three patients underwent EST for acute biliary pancreatitis, and one patient required re-ERCP and cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Is Cholecystectomy Necessary After ERCP for Bile Duct Stones in Patients with Gallbladder in situ ?

Kwon

Lee

Kim

et al. 2001

Korean J Intern Med

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BackgroundThe requirement for subsequent cholecystectomy in patients with gallbladder in situ after endoscopic removal of stones from the common bile duct (CBD) is controversial. The aims of this study were to assess the requirement for subsequent cholecystectomy for gallbladder-related symptoms, and to identify the patients who develop symptoms after the endoscopic removal of CBD stones.MethodsOf 241 patients with gallbladder in situ following endoscopic removal of stones from the CBD, 146 patients (78 men and 68 women; mean age 69±13 years, range 20–93) with a follow-up time of more than three months without elective cholecystectomy were enrolled in the study. Fifty-nine patients had gallbladder stones (single stones in 27 and multiple stones in 32) and 87 patients had gallbladder in situ without stones. The time from entry to the occurrences of death or cholecystectomy was evaluated retrospectively. Cox regression analysis was used to evaluate the risk factors associated with these events.ResultsThe mean duration of follow-up was 24.1±18.0 months (range 3–70 months). During follow-up, seven patients (4.8%) underwent cholecystectomy, on average 18.4 months after CBD stone removal, as the result of acute cholecystitis in four cases, biliary pain in two cases and acute pancreatitis in one case. Laparoscopic cholecystectomy was performed in four patients and open cholecystectomy in three patients. Post-operative morbidity occurred in two patients, with improvement after conservative management. Nine patients (6.2%) died as the result of unrelated biliary disease. Age, sex, presence of gallbladder stones, multiplicity of gallbladder stones and underlying disease did not correlate with subsequent cholecystectomy by Cox regression analysis.ConclusionElective cholecystectomy is not warranted in patients with bile duct stones when the common duct can be cleared of stones by endoscopic sphincterotomy. We could not find any clinical predictors of further symptoms or complications arising from the retained gallbladder.

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“…Sphincterotomy decreases recurrence rates by promoting pancreatic and common bile duct outflow [14]. In gallstone patients with a gallbladder in situ, sphincterotomy decreases crystallization mainly by lowering cholesterol and total lipid concentrations [68,69]. Sphincterotomy after previous cholecystectomy has no significant effect on cholesterol or total lipid concentrations [70,71].…”

Section: Manipulation Of Biliary Lipids and Water: Secondary Preventimentioning

confidence: 99%

Pharmacological Manipulation of Biliary Water and Lipids: Potential Consequences for Prevention of Acute Biliary Pancreatitis

Venneman¹,

vanBerge-Henegouwen²,

Erpecum³

2005

curr drug targets immune endocr metabol disord

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Acute biliary pancreatitis, caused by macroscopic cholesterol gallstones or microlithiasis, is often a severe disease with considerable morbidity and mortality. Formation of cholesterol gallstones and microlithiasis is caused by cholesterol crystallization from cholesterol supersaturated gallbladder bile. Particularly patients with fast and extensive crystallization, due to highly concentrated bile, low biliary phospholipid contents and gallbladder mucin hypersecretion seem at risk for pancreatitis. Patients who suffered from acute biliary pancreatitis should undergo cholecystectomy as secondary prevention strategy. For patients at high surgical risk, endoscopic sphincterotomy may be an appropriate alternative. Pharmacological manipulation of biliary lipids by the hydrophilic bile salt ursodeoxycholic acid is reserved for patients with recurrent pancreatitis despite previous cholecystectomy or sphincterotomy, or with contraindications to surgical and endoscopic treatment. Maintenance therapy with ursodeoxycholic acid is however a very effective secondary prevention strategy. Potentially, secondary prevention of acute biliary pancreatitis could also be achieved through decreasing biliary mucin contents by UDCA, NSAIDs or N-acetylcystein, or through achieving bile dilution (currently not feasible).

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Effect of Endoscopic Sphincterotomy on Bile Lithogenicity in Patients with Gallbladder In Situ

Abstract: Endoscopic sphincterotomy causes a marked decrease in the lithogenicity of bile and thus may prevent the risk of recurrence of cholesterol lithiasis.

Cited by 6 publications

References 12 publications

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

Is Cholecystectomy Necessary After ERCP for Bile Duct Stones in Patients with Gallbladder in situ ?

Pharmacological Manipulation of Biliary Water and Lipids: Potential Consequences for Prevention of Acute Biliary Pancreatitis

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