Document Detail

Cholecystectomy after endoscopic sphincterotomy for common bile duct stones: is surgery necessary?
MedLine Citation:
PMID:  16224638     Owner:  NLM     Status:  MEDLINE    
It has been more than 30 years since the introduction of endoscopic sphincterotomy for the management of choledocholithiasis. Once introduced, this endoscopic intervention subsequently enabled clinicians to witness the natural history of leaving the gallbladder in situ once the common duct calculi were removed. Because many people were free of symptoms once the common bile duct was cleared of stones, patients and physicians alike soon questioned whether it was necessary to remove the gallbladder at all. Despite more than two decades of clinical research and numerous published reports, the answer to this question remains elusive. Similarly, the management algorithm for choledocholithiasis in patients with an intact gallbladder remains controversial. We review the available key data regarding this question. Importantly, there are only three prospective, randomized trials that have examined the need for cholecystectomy after endoscopic sphincterotomy, with case studies constituting most of the published reports. Consequently, the literature on this topic remains inconclusive, weakened by its retrospective approach, considerable variability between the patients studied, inconsistent inclusion and exclusion criteria, and frequently poor patient follow-up. Nonetheless, the preponderance of data favor removing the gallbladder after endoscopically clearing the common bile duct of gallstones because an estimated 25% of patients will experience recurrent symptoms within a 2-year follow up period. Recognizing the existence of various mitigating clinical factors, we advocate adopting a selective wait-and-see approach for high-risk patients, especially those with a life expectancy of less than 2 years or severely debilitating comorbidities.
Hobart W Harris; Brian R Davis; Gary C Vitale
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Surgical innovation     Volume:  12     ISSN:  1553-3506     ISO Abbreviation:  -     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-10-14     Completed Date:  2006-02-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101233809     Medline TA:  Surg Innov     Country:  United States    
Other Details:
Languages:  eng     Pagination:  187-94     Citation Subset:  IM    
Division of General Surgery, University of California, San Francisco, San Francisco, CA, USA.
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MeSH Terms
Cholangiopancreatography, Endoscopic Retrograde / methods
Cholecystectomy / methods*
Choledocholithiasis / diagnosis,  surgery*
Follow-Up Studies
Postoperative Complications / epidemiology
Prospective Studies
Randomized Controlled Trials as Topic
Risk Assessment
Sphincterotomy, Endoscopic / methods*
Treatment Outcome
Unnecessary Procedures*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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