Decision-Making in Patients with Gallstones: Development of a Clinical Algorithm Using the Instrument of a Consensus Development Conference

Abstract

Since decision-making in patients with gallstone disease is a very common medical problem, a carefully planned consensus development conference was held to develop a clinical algorithm using an electronically transmitted group response of the panel and the general audience. Only symptomatic patients are candidates for treatment. Minimal diagnostic requirements are ultrasound, determination of leukocytes, alkaline phosphatase and bilirubin in the blood, and preoperative intravenous cholangiography. Detected common duct stones should nowadays be removed by endoscopic retrograde cholangiopancreatography. Symptomatic gallbladder stones are managed by laparascopic cholecystectomy as the new standard treatment. Conventional cholecystectomy should be done in patients with liver cirrhosis and portal hypertension, suspicion of cancer, certain cases of severe, acute or chronic inflammation, severe adhesions in the upper abdomen and pregnancy. Medical stone dissolution and extracorporeal shock-wave lithotripsy should be restricted to a small group of patients with a high surgical risk and who have small, roentgen-negative stones and a patent gallbladder.

Klinische Studien in der Notfallmedizin

“…Die Anzahl dieser Runden wird vorher festgelegt, und am Ende steht die Formulierung einer gemeinsamen Gruppenmeinung in Form eines klinischen Algorithmus [27,76] Die grundlegende Idee ist, daß jeder Teilnehmer seine Meinung vorträgt, und diese Einzelmeinungen allen Gruppenmitgliedern mitgeteilt werden.…”