Abstract | INTRODUCTION: Prophylactic cholecystectomy (PC) is advised after ES and clearance of ductal calculi on the basis of a randomized controlled trial that showed a requirement for cholecystectomy in 36% of patients who defer surgery. Other studies suggest the cholecystectomy rate to be as low as 8%. METHOD: To determine the proportion of patients who deferred cholecystectomy and the outcome, we reviewed 870 consecutive patients who underwent endoscopic retrograde cholangiography and sphincterotomy; the gallbladder of 420 of these remained in situ. Patients were assigned to PC or deferred cholecystectomy (DC) groups. RESULTS:
Cholecystectomy was deferred in 180 of 310 eligible patients. DC patients were significantly older (66.4 v. 49.8 yr) and sicker (according to the American Society of Anesthesiology [ASA] physiological status score) and had a significantly higher mortality rate than did PC patients. Deaths were principally cardiovascular and not biliary related. After a follow-up of 24.2 (<1-82.3) months, eventual cholecystectomy was required in 46 (24.7%) DC patients at a mean of 6 months after ES. The subgroup undergoing eventual cholecystectomy was younger (57.6 v. 69.4 yr; p<0.001) fitter (ASA score of 1.98 v. 2.26; p=0.015) and more likely to have residual cholecystolithiasis than were those who continued deferral. Recurrent pancreatitis was more common in DC (30%) than in PC (4.8%) patients if pancreatitis was the indication for sphincterotomy. DISCUSSION:
|
Authors | Jason D Archibald, Jonathan R Love, Vivian C McAlister |
Journal | Canadian journal of surgery. Journal canadien de chirurgie
(Can J Surg)
Vol. 50
Issue 1
Pg. 19-23
(Feb 2007)
ISSN: 0008-428X [Print] Canada |
PMID | 17391611
(Publication Type: Journal Article)
|
Topics |
- Age Factors
- Aged
- Cause of Death
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy
- Cholecystolithiasis
(complications)
- Cholelithiasis
(surgery)
- Cohort Studies
- Follow-Up Studies
- Humans
- Middle Aged
- Patient Compliance
- Physical Fitness
- Retrospective Studies
- Severity of Illness Index
- Sphincterotomy, Endoscopic
- Survival Rate
- Treatment Outcome
- Treatment Refusal
|