Long-term follow-up of a prospective randomized study of endoscopic <i>versus</i> surgical treatment of bile duct calculi in patients with gallbladder <i>in situ</i>

Hammarström, Lars-Erik; Holmin, T.; Stridbeck, H.; Ihse, Ingemar

doi:10.1002/bjs.1800821121

Cited by 103 publications

(61 citation statements)

References 43 publications

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“…The answer is not straightforward. McAlister et al performed a metaanalysis that included five prospective randomized trials [9,[80][81][82][83] showing the benefit of an additional cholecystectomy after ES in case of symptomatic gallstone diseases, including ABP [84]. An additional cholecystectomy resulted in a lower death rate (7.9% vs 14.1%; p = 0.01) even in studies that included patients from higher-risk American Society of Anesthesiology (ASA) classes.…”

Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

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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Section: Endoscopic Sphincterotomy Versus Conservative Managementmentioning

confidence: 99%

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

et al. 2009

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“…9 Hammarstrom et al also found both procedures equally effective in the elderly in the long term, though suggesting surgery to be the better option due to significantly increased mortality from heart disease in those having ERCP compared to cholecystectomy. 10 Minimal intervention utilising percutaneous cholecystostomy (PC) has been suggested as a suitable alternative to cholecystectomy in the critically ill patient. It has a low procedure-related morbidity and mortality, and the literature available suggests that there is early resolution of acute symptoms.…”

mentioning

confidence: 99%

Management of gallstone disease in the elderly

Arthur¹,

Edwards²,

Chagla³

2003

Annals of the Royal College of Surgeons of England

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T he latter half of the 20th century saw an increase in the incidence of gallstone disease (GSD) in Britain. This was partly due to the increasing age of the population. It is estimated that up to 28% and 42% of men and women, respectively, aged 80-89 years have gallstones. Of these, 30% are symptomatic, and are seen by surgeons around Conclusions: This study suggests that recurrent GSD in elderly patients managed non-operatively may have fatal outcome. Elective cholecystectomy has acceptable morbidity and mortality in this age group and there is often ample opportunity to avoid emergency surgery, but a prospective randomised study is required to improve clinical algorithms.

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“…The percentage of retained stones only 1% -3%, and during long-term followup revisional surgery was necessary in about 10% of the patients. [2][3][4][5] With the advent of minimal access surgical techniques and endoscopic access to our armamentarium, the modern surgeons' experience with the traditional open CBD exploration is fast decreasing.…”

Section: Discussionmentioning

confidence: 99%