Endoscopic Treatment of Bile Duct Calculi in Patients with Gallbladder in Situ Long-Term Outcome and Factors Predictive of Recurrent Symptoms

Le, Hammarström; Holmin, T.; Stridbeck, H.

doi:10.3109/00365529609004881

Cited by 49 publications

(32 citation statements)

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“…In the present study, the development of acute cholecystitis (17%) was more common than that of CBD stone (13%) recurrence after CBD stone removal. We believed that if the risk factors of acute cholecystitis in patients who receive an endoscopic CBD stone removal could be identified, we might be able to identify the indicators of prophylactic cholecystectomy, as has been mentioned by earlier investigators [13] . Some studies have compared the results of prophylactic cholecystectomy and non-surgical treatment [7,9,17] .…”

Section: Discussionmentioning

confidence: 90%

“…Because two patients in whom acute cholecystitis developed also experienced CBD stone recurrence and there was no case of cholangitis or CBD stricture, the overall recurrence rate of biliary-related events during follow-up after endoscopic CBD stone removal was 28% (28/100), which is similar to the rates of 5-24% reported www.wjgnet.com recent prospective [7] and large scale cohort studies [9] produced contrary conclusions concerning prophylactic cholecystectomy vs the wait-and-see approach. Moreover, because no consensus has been reached, the decision as to whether to operate or not is made empirically on a case-by-case basis [8,13,[17][18][19] . However, two important points should not be missed.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

Ryu¹,

Park

Yoon³

et al. 2006

WJG

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have a higher risk of acute cholecystitis and are possible candidates for prophylactic cholecystectomy. INTRODUCTIONEndoscopic sphincterotomy is the treatment of choice for patients with common bile duct (CBD) stones. The high success rate and safety of this modality have been well established by a number of studies [1][2][3][4][5] . Because gallstones may pass from the gallbladder (GB) into the CBD, calculous GB is considered to be one of the risk factors for the recurrence of bile duct stones after sphincterotomy [4,6] . Some studies have compared the results of the wait-andsee policy and prophylactic cholecystectomy to prevent biliary complications but arrived at contradictory results [7][8][9] . Thus, it still remains controversial as to whether subsequent laparoscopic cholecystectomy is indicated in patients with concurrent GB stones. Most studies have focused on the identification of predictors of CBD stone recurrence, which can be treated again endoscopically without surgery; however, the development of acute cholecystitis is a definite indication of cholecystectomy. So the risk factors of subsequent acute cholecystitis are more important than those of recurrent CBD stones in terms of the decision concerning prophylactic cholecystectomy. However, few studies have identified the risk factors of acute cholecystitis after endoscopic CBD stone removal in patients with GB in situ. The aims of this study were to assess the risks of biliary symptom recurrence and to identify the risk factors of acute cholecystitis in patients with GB in situ who have received endoscopic CBD stone removal. MATERIALS AND METHODS PatientsThe medical records of patients with GB in situ who Abstract AIM: To evaluate the risk factors of acute cholecystitis after endoscopic common bile duct (CBD) stone removal.PO Box 2345, Beijing 100023, China World J Gastroenterol 2006 February 14; 12(6): 956-960 www.wjgnet.com World Journal of Gastroenterology ISSN 1007-9327 wjg@wjgnet.com © 2006 The WJG Press. All rights reserved. RAPID COMMUNICATION METHODS:A total 100 of patients who underwent endoscopic CBD stone removal with gallbladder (GB) in situ without subsequent cholecystectomy from January 2000 to July 2004 were evaluated retrospectively. The following factors were considered while evaluating risk factors for the development of acute cholecystitis: age, gender, serum bilirubin level, GB wall thickening, cystic duct patency, presence of a GB stone, CBD diameter, residual stone, lithotripsy, juxtapapillary diverticulum, presence of liver cirrhosis or diabetes mellitus, a presenting illness of cholangitis or pancreatitis, and procedure-related complications. RESULTS:During a mean 18-mo follow-up, 28 (28%) patients developed biliary symptoms; 17 (17%) acute cholecystitis and 13 (13%) CBD stone recurrence. Of patients with acute cholecystitis, 15 (88.2%) received laparoscopic cholecystectomy and 2 (11.8%) open cholecystectomy. All recurrent CBD stones were successfully removed endoscopically. The mean time elapse to acute cholecystitis was 1...

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

Ryu¹,

Park

Yoon³

et al. 2006

WJG

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“…Of those patients initially treated using ES, 35% required an additional cholecystectomy during the follow-up period. It is reported that 2% to 33% of patients with symptomatic choledocholithiasis require an additional cholecystectomy, suggesting that patients with ABP are at greater risk for late gallstone-related complications [75][76][77]. This also is supported by the observation that 15% of the patients from the Hammarstrom study required an emergency cholecystectomy after ES, compared with only 4% to 6% of patients presenting with symptomatic gallstone disease but not ABP [8,75].…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 91%

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

et al. 2009

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Background Recurrent attacks of acute biliary pancreatitis (RABP) are prevented by (laparoscopic) cholecystectomy. Since the introduction of endoscopic retrograde cholangiopancreaticography (ERCP), several series have described a similar reduction of RABP after endoscopic sphincterotomy (ES). This report discusses the different treatment options for preventing RABP including conservative treatment, cholecystectomy, ES, and combinations of these options as well as their respective timing. Methods A search in PubMed for observational studies and clinical (comparative) trials published in the English language was performed on the subject of recurrent acute biliary pancreatitis and other gallstone complications after an initial attack of acute pancreatitis. Result Cholecystectomy and ES both are superior to conservative treatment in reducing the incidence of RABP. Cholecystectomy provides additional protection for gallstone-related complications and mortality. Observational studies indicate that cholecystectomy combined with ES is the most effective treatment for reducing the incidence of RABP attacks.Conclusion From the literature data it can be concluded that ES is as effective in reducing RABP as cholecystectomy but inferior in reducing mortality and overall morbidity. The combination of ES and cholecystectomy seems superior to either of the treatment methods alone. A prospective randomized clinical trial comparing ES plus cholecystectomy with cholecystectomy alone is needed.Keywords Acute biliary pancreatitis Á Cholecystectomy Á Endoscopic sphincterotomy Á ERCP Á Recurrent Acute biliary or gallstone pancreatitis (ABP) is an inflammatory condition of the pancreas induced by gallstones [1]. The initial treatment of ABP can be either conservative or interventional. The coexistence of cholangitis is an accepted indication for the performance of endoscopic retrograde cholangiopancreaticography (ERCP). However, whether this procedure is performed for patients with ABP depends on local expertise and guidelines, as is the decision to perform an endoscopic sphincterotomy (ES) [2][3][4][5].After patients have recovered from their first attack of ABP, most guidelines advocate a cholecystectomy to prevent a recurrent attack or other gallstone-related disorders such as symptomatic choledocholithiasis, cholecystitis, gallstone ileus, jaundice, and cholangitis [2][3][4][5]. ''Recurrent'' symptomatic choledocholithiasis after an initial attack of ABP may be preexisting common bile duct (CBD) stones not detected at the time of the primo episode or stones that migrated from the gallbladder into the CBD after initial stone clearance. Choledocholithiasis also may have developed newly within the bile duct after cholecystectomy.

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“…On the one hand, it is possible that advancing technology and overall improved quality of medical care allow for better outcomes, but on the other hand, more aggressive approaches in the elderly and in those patients with higher numbers of medical coexisting conditions might confer a worse prognosis. Public reports of complications and mortality rates after endoscopic biliary sphincterotomies mainly belong to the last decades of the twentieth century (3)(4)(5). Recent literature on the topic mostly focuses on comparing the outcomes after endoscopic biliary dilation vs endoscopic biliary sphincterotomies alone (6)(7)(8), but in our own experience the numbers of patients undergoing one or another procedure are very dissimilar.…”

Section: Introductionmentioning

confidence: 99%

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

et al. 2016

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We aimed to compare incidence and outcomes for endoscopic biliary sphincterotomies in people with or without type 2 diabetes mellitus (T2DM) in Spain (2003Spain ( -2013.We collected all cases of endoscopic biliary sphincterotomies using national hospital discharge data and evaluated annual incidence rates stratified by T2DM status. We analyzed trends over time for in-hospital mortality (IHM) as the primary outcome and a composite of IHM or procedure-related complications (key secondary outcome). In multivariate analyses, we tested T2DM as an independent factor of IHM and IHM or complications.We identified 126,885 endoscopic biliary sphincterotomies (23,002 [18.1%] in T2DM people). Crude incidence rates of endoscopic biliary sphincterotomies were > 3-fold higher in people with vs without T2DM (85.5/10 5 vs 26.9/10 5 population, respectively). Annual incidence rates of endoscopic biliary sphincterotomies showed 11-year relative increments of 77.5% (from 60.0 to 106.5/105) in T2DM, and 53.7% (from 21.6 to 33.2/105) in non-T2DM people (p < 0.001). We found no significant changes in mortality trends over time for the populations with or without T2DM (p = 0.15 and p = 0.21, respectively). Rates of procedural pancreatitis decreased in people without T2DM (p < 0.001). In the multivariate analysis, older age, higher comorbidity and endoscopic biliary sphincterotomy during urgent admission were associated with a higher IHM. T2DM was associated with a lower IHM after an endoscopic biliary sphincterotomy Further studies are needed to confirm a lower IHM for endoscopic biliary sphincterotomies in people with T2DM.

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Endoscopic Treatment of Bile Duct Calculi in Patients with Gallbladder in Situ Long-Term Outcome and Factors Predictive of Recurrent Symptoms

Abstract: These findings confirm that endoscopic treatment alone in this group of patients is a feasible treatment principle. Recognition of the registered risk factors might be helpful when selecting patients for subsequent cholecystectomy.

Cited by 49 publications

References 34 publications

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

Risk factors of acute cholecystitis after endoscopic common bile duct stone removal

Recurrent acute biliary pancreatitis: the protective role of cholecystectomy and endoscopic sphincterotomy

Tendencies and outcomes in endoscopic biliary sphincterotomies among people with or without type 2 diabetes mellitus in Spain, 2003-2013

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