Risks of leaving the gallbladder in situ after endoscopic sphincterotomy for bile duct stones

Abstract

There is controversy concerning the subsequent clinical course of patients whose gallbladder is left in situ following successful endoscopic removal of stones from their common bile ducts. A total of 191 patients (median age 76 years) were reviewed between 12 and 100 months (mean 38 months) after endoscopic sphincterotomy. Ten patients (5.2 per cent) had symptoms requiring cholecystectomy which was uneventful, nine in the first year. Cholangitis at presentation or failure to fill the gallbladder by endoscopic retrograde cholangiography were not helpful in identifying these patients. Forty-nine (25.6 per cent) patients died during the review period from non-biliary pathology (usually cardiovascular). Elective cholecystectomy is not required in elderly patients with symptomatic bile duct stones if the common bile duct can be cleared of stones after endoscopic sphincterotomy.

Practice Guidelines in Acute Pancreatitis

“…Some studies have suggested the effectiveness of endoscopic biliary sphincterotomy in these circumstances in preventing further episodes of acute biliary pancreatitis. These uncontrolled case series mostly suggest a reduction in the frequency of attacks of pancreatitis, although recurrent bile duct stones or acute cholecystitis may still be a problem in the future (255)(256)(257)(258)(259)(260)(261)(262)(263)(264). Before considering an empiric biliary sphincterotomy for recurrent pancreatitis with or without abnormal liver function tests, the clinician must be aware of the possibility of an alternative etiology, such as sphincter of Oddi dysfunction, especially in women, young or middleaged patients, and patients who are postcholecystectomy, or do not have clearly documented gallstone disease.…”

Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high‐risk surgical patients: a decision analysis

“…[1][2][3] Endoscopic stone extraction is successful in over 96% of patients [3][4][5] with a low procedure-related morbidity (5.8%) and mortality (0.2%). 3 Subsequent laparoscopic cholecystectomy (LC) is the standard treatment in those patients with concomitant gall-bladder stones.…”

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct stones

“…Many authors have advocated a wait-and-see policy after ES for these patients because only an estimated 10% of them experience recurrent biliary symptoms in retrospective and nonrandomized studies [4][5][6][7][8]. However, in two prospective randomized trials, up to 47% of the patients presented with recurrent biliary symptoms after a wait-and-see policy, and the cumulative risk for death was 21% within 5 years (vs 5.8% for patients allocated to planned cholecystectomy) [9,10].…”