Long-term follow-up study of gallbladder in situ after endoscopic common duct stone removal in Korean patients

Abstract

Prophylactic cholecystectomy seems to be unnecessary in patients without GB stones after endoscopic sphincterotomy. However, in patients with GB stones, elective cholecystectomy or close observation is recommended due to the higher risk of cholecystitis.

Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy

“…214 D ELAYED COMPLICATIONS OTHER than recurrent gallstones of the common bile duct include cholecystitis, cholangitis, and hepatic abscess. 188,189,191,192,197,210,[215][216][217][218][219][220][221][222][223][224][225] With regards to preventive cholecystectomy in the gallbladder without stones, the incidence of cholecystitis as a delayed complication is not high and, therefore, most reports indicate that preventive cholecystectomy is not required. For gallbladders with stones, the Japanese clinical guidelines for cholelithiasis indicate that in asymptomatic patients with gallstones, the cumulative rate of symptomatic change was 2% to 4% per year and, although close follow up was required, proactive preventive cholecystectomy is not recommended.…”

“…Delayed complications other than recurrent gallstones of the common bile duct include cholecystitis, cholangitis, and hepatic abscess …”

Updated guideline on the management of common bile duct stones (CBDS)

“…In contrast, smaller studies of both Asian154–157 and European patients158–160 have not been able to clearly demonstrate a higher likelihood of recurrent CBDS following duct clearance in patients with gall bladder stones. However, several reports suggest that patients with an empty gall bladder have a lower risk of cholecystitis and subsequent cholecystectomy 155 158 160. Surgeons may therefore wish to discuss a wait and see approach with patients who have an empty gall bladder following duct clearance.…”

Late two‐stage laparoscopic cholecystectomy is associated with an increased risk of major bile duct injury

“…High‐risk surgical patients whose CBD stones have been cleared with ERCP can be managed conservatively . On the other hand, a long interval between ERCP and LC is associated with an increased rate of recurrent biliary events, including biliary colic, recurrent CBD stones, attacks of cholangitis, acute cholecystitis and mortality …”