| Cholecystectomy after endoscopic sphincterotomy for common bile duct stones: is surgery necessary? | |
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MedLine Citation:
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PMID: 16224638 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Hobart W Harris; Brian R Davis; Gary C Vitale |
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Publication Detail:
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Type: Comparative Study; Journal Article; Review |
Journal Detail:
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Title: Surgical innovation Volume: 12 ISSN: 1553-3506 ISO Abbreviation: - Publication Date: 2005 Sep |
Date Detail:
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Created Date: 2005-10-14 Completed Date: 2006-02-28 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 101233809 Medline TA: Surg Innov Country: United States |
Other Details:
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Languages: eng Pagination: 187-94 Citation Subset: IM |
Affiliation:
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Division of General Surgery, University of California, San Francisco, San Francisco, CA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cholangiopancreatography, Endoscopic Retrograde
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methods Cholecystectomy / methods* Choledocholithiasis / diagnosis, surgery* Female Follow-Up Studies Humans Male 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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