Usefulness of endoscopic ultrasound in patients with minilithiasis and/or biliary sludge as a cause of symptoms of probable biliary origin after cholecystectomy.

Abstract

INTRODUCTION:

Endoscopic ultrasound (EUS) is a more sensitive technique than transabdominal ultrasound for the diagnosis of gallstones. This greater sensitivity, especially in the diagnosis of microlithiasis/biliary sludge, facilitates the indication of cholecystectomy in patients with symptoms of probable biliary origin but may result in over-indication of this surgery.

OBJECTIVES:

Evaluate the role of EUS in the diagnosis of minilithiasis/biliary sludge in patients with digestive symptoms of probable biliary origin by resolving the symptoms after cholecystectomy. Analyse factors related to the remission of symptoms following cholecystectomy.

PATIENTS AND METHODS:

Retrospective, longitudinal, single-centre study based on a prospective database of 1.121 patients undergoing EUS. Seventy-four patients were identified as meeting inclusion-exclusion criteria (diagnosed with minilithiasis/sludge by EUS after presenting digestive symptoms of probable biliary origin without a history of complicated cholelithiasis). A telephone questionnaire for symptoms was conducted with cholecystectomized patients. Factors related to a good response were analysed with logistic regression analysis.

RESULTS:

Of the 74 patients, 50 were cholecystectomized (67.5%), mean age 49 years (SEM 2.26) (41 women). Seventy percent of patients (35/50) presented remission of symptoms with median follow-up 353.5 days (95% CI, 270-632.2). The only variable associated with remission of symptoms was the presence of typical biliary colic with an OR of 7.8 (95% CI, 1.8-34; p=0.006). No complications associated with EUS were recorded. One patient (2%) suffered haemoperitoneum and 18% (9/50) suffered diarrhoea following cholecystectomy.

CONCLUSIONS:

EUS is a very useful technique for the indication of cholecystectomy in patients with minilithiasis/sludge and typical symptoms of biliary colic.

• Authors: Andrea Montenegro, Xavier Andújar, Fernando Fernández-Bañares, María Esteve, Carme Loras
• Journal: Gastroenterologia y hepatologia (Gastroenterol Hepatol) Vol. 45 Issue 2 Pg. 91-98 (Feb 2022) ISSN: 0210-5705 [Print] Spain
• PMID: 34023476 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

Topics

• Bile (diagnostic imaging)
• Cholecystectomy (adverse effects, statistics & numerical data)
• Colic (epidemiology)
• Diarrhea (epidemiology)
• Endosonography
• Female
• Gallstones (diagnostic imaging, surgery)
• Humans
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Remission Induction
• Retrospective Studies
• Symptom Assessment