Journal article
The fate of patients who undergo “preoperative” ERCP to clear known or suspected bile duct stones
Surgical endoscopy, Vol.23(1), pp.74-79
01/2009
DOI: 10.1007/s00464-008-9903-2
PMID: 18401646
Abstract
There is debate as to whether recurrent biliary complications are more common in patients who do not have elective cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) management of common bile duct (CBD) stones. The aim of this study was to determine the fate of patients with intact gallbladders who have had CBD stones removed at ERCP, and to assess their risk of recurrent biliary symptoms.We retrospectively identified all patients in our large tertiary center population with intact gallbladders who had an ERCP for CBD stones from December 1999 to March 2002. We determined which patients had subsequent elective cholecystectomy, and the outcomes of patients who did not have elective surgery.309 patients had CBD stones at ERCP during the study period, of which 139 had intact gallbladders at the time of ERCP. Of these 139 patients 59 had subsequent elective cholecystectomy, 11 by open operation and 48 laparoscopically. Of these 139 patients, 27 had cholecystectomy planned; 47 patients were managed with a wait-and-see strategy, 30 of whom were poor surgical candidates. Of these 47 patients in whom a wait-and-see policy was adopted, 9 (19%) developed complications including recurrent pain and/or abnormal liver function tests (LFTs), recurrent biliary colic, and pancreatitis. Eight of these nine patients were from the poor surgical candidate group. Sphincterotomy had been performed at initial ERCP in all patients.Over half of our population of 139 patients with CBD stones at ERCP and intact gallbladders had actual or planned elective cholecystectomy. For those patients in whom a decision to wait-and-see was made, almost 20% developed complications. Elective cholecystectomy after a finding of choledocholithiasis is supported by many and is a common strategy in our experience. Recurrent biliary complications are relatively common in those who do not undergo elective cholecystectomy, especially those patients who represent a high operative risk.
Details
- Title: Subtitle
- The fate of patients who undergo “preoperative” ERCP to clear known or suspected bile duct stones
- Creators
- M F Byrne - Division of Gastroenterology University of British Columbia 5135-2775 Laurel Street Vancouver BC Canada V5Z 1M9M T McLoughlin - Division of Gastroenterology University of British Columbia 5135-2775 Laurel Street Vancouver BC Canada V5Z 1M9R M Mitchell - Division of Gastroenterology Belfast City Hospital Belfast Northern Ireland, UKH Gerke - Division of Gastroenterology and Hepatology University of Iowa Hospital and Clinics Iowa City IA USAT Pappas - Department of Medicine and Surgery Duke University Medical Center Durham NC USAM Branch - Department of Medicine and Surgery Duke University Medical Center Durham NC USAP Jowell - Department of Medicine and Surgery Duke University Medical Center Durham NC USAJ Baillie - School of Medicine Wake Forest University Baptist Medical Center Winston Salem NC USA
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.23(1), pp.74-79
- Publisher
- Springer-Verlag
- DOI
- 10.1007/s00464-008-9903-2
- PMID
- 18401646
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Language
- English
- Date published
- 01/2009
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984094493002771
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