The Impact of Gallbladder Status on Biliary Complications After the Endoscopic Removal of Choledocholithiasis

Abstract

Prophylactic cholecystectomy may not be necessary to prevent biliary complication in patients with acalculous gallbladder after endoscopic removal of pigment stones from bile duct.

Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment?

“…Following the endoscopic treatment of CBDS, recurrent biliary complication occurred in 3–21% of patients after EST [12] and in 5–25% of patients after EPBD [28]. Calculus gallbladder was identified as one of the factors that is responsible for such complications [29]. EPLBD, using balloon ≥12 mm, is a safe and effective method in facilitating the removal of CBDS as seen, but is not a sphincter-preserving procedure [30].…”

“…Endoscopic treatment of the biliary sphincter by either EST or endoscopic sphincterotomy plus large balloon dilation (ESLBD) may increase the gallbladder motility, facilitating the spontaneous passing of gallstones and increasing the risk of recurrent biliary complications, particularly gallbladder complications [38]. Except in cases of gallbladder-related complications, elective cholecystectomy does not help to prevent recurrent CBDS or cholangitis [29, 39]. Other studies have shown that prior cholecystectomy may be a factor in causing the recurrent CBDS [12, 40, 41].…”

“…These contradictory results raise a question regarding who will benefit from elective cholecystectomy following endoscopic treatment for CBDS. Some studies claimed that prophylactic cholecystectomy is not required in patients with acalculous gallbladder following endoscopic clearance of the bile duct [29], but elective cholecystectomy in patients with calculus gallbladder following endoscopic treatment is recommended owing to the risk of subsequent recurrent biliary complications [42, 43]. However, most relevant studies that strongly recommend routine cholecystectomy neglect the evidence of the spontaneous clearance of the gallbladder following endoscopic treatment.…”

Advances in Gallbladder-Preserving Surgery for Gallbladder Diseases

“…The existing literature shows that the scientific nature of relevant research is insufficient. There is no definite high-level report on how to prevent the recurrence of gallstones after gallstone-conserving surgery [60]. The exact effect of ursodeoxycholic acid or other methods to prevent stone recurrence remains to be confirmed.…”

Choledocholithiasis Without Cholelithiasis: Should the Gallbladder Stay or Should It Go?

“…In the current issue of Digestive Diseases and Sciences, Kim et al [8] retrospectively describe the natural history of 453 South Korean patients with bile duct stones who underwent ERCP with sphincterotomy and/or balloon dilation for stone removal between 1998 and 2000, but did not undergo cholecystectomy. Concurrent cholelithiasis was present in 256 (57 %) patients and absent in 197 (43 %).…”