Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment
Keywords:Laparoscopic cholecystectomy, Endoscopic sphinterotomy, CBD stones.
Introduction:There is no consensus regarding the ideal management of concurrent gallbladder and common bile duct (CBD) stones. Currently the treatment protocol involves most commonly a sequential approach consisting of endoscopic sphincterotomy followed by laparoscopic cholecystectomy or a single stage laparoscopic procedure, including cholecystectomy and exploration of the CBD.Methods: Patients with an intact gallbladder and CBDS after endoscopic clearance of bile duct were enrolled. Patients received a fatty meal sonography after liver function returned to normal. The fasting volume, residual volume, and gallbladder ejection fraction (GBEF) in FMS were measured. Relationships of patients’ characteristics, gallbladder function and recurrent biliary complication were analyzed.Results: Gallbladder stones were identified in 58 patients by an abdominal sonogram or a CT before endoscopic treatment.19 patients were acute biliary pancreatitis. Thirteen patients had a juxtapapillary diverticulum. The mean common bile duct diameter was 1.3 ± 0.2 cm. Thirteen patients received endoscopic sphincterotomy (EST), while 90 patients received EPBD to enlarge the papillary orifice. In the patients who received EPBD, the mean diameter of the balloon was 1.0 ± 0.1 cm. Nine patients received mechanical lithotripsy to retrieve stones. The mean duration of the procedure was 53.2 ± 7.3 min. Conclusions: Gallbladder motility function was poorer in patients with a calculus gallbladder, but it cannot predict the recurrent biliary complication. Since spontaneous clearance of gallbladder stone may occur, wait and see policy of gallbladder management after endoscopic treatment of CBDS is appropriate, but regular follow- up in those patients with risk factors for recurrence is necessary.
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Copyright (c) 2021 Ashish. S. Rudrawadi, Sahadevan Vijay
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