A Study of Necessity for Cholecystectomy after Endoscopic Commom Bile Duct Stone Removal

Park, Chan Won; Kim, Jun Hwan; Lee, Dong Jun; Kim, Ki Yun; Suh, Jeong Ill; Kim, Tae Nyeun; Chung, Moon Kwan

Abstract

BACKGROUND/AIMS: There has been much debate over the fate of the gallbladder after endoscopic common bile duct stone removal. Current data suggest that the majority of patients remain asyrnptomatic and without complications related to the gallbladder when endoscopic extraction of the bile duct stones is successful. The aims of this study was to assess the natural course of patients with gallbladder in situ following endoscopic sphincterotomy for choledocholithiasis with particular reference to the need for subsequent cholecystectorny.
METHODS
Patients were studied who had undergone comon bile duct stone removal by endoscopic sphincterotorny at Yeungnam University hospita] between January 1988 and July 1993. The patients were followe < l regularly by phone call and personal interview at our outpatient clinic. The overall length of fo]low-up ranged from 6 months to 70 months. When more detailed information was required, a new investigation was undertaken by liver function test, abdominal ultrasonography, or endoscopic retrograde cholangiopancreatography.
RESULTS
Immediate complications of endoscopic sphincterotomy occurred in 26 patients(14.5%), of which hemorrhage was the most frequent. 2 of 21 patients required pack cell transfusion for bleeding. Acute pancreatitis occurred in 5 paients, which was successfully managed by conservative treatment. Three patients in group of gallbladder in situ without gallstone required cholecystectorny for symptoms or complication related to the gallbladder calculi. The reason for surgery were acute cholecystitis in two patients, biliary colic in one. In the group of gallbladder in situ with gallstone one patient required cholecystectomy for GB empyema. The frequency of cholecystectomy was not significantly different between two groups. Recurrence of common bile duct stone was observed in 4 patients of the group without gallbladder(5.6%) and 7 patients of the group with gallbaldder in situ(6.5%). The recurrence rate was nqt significantly different between two groups.
CONCLUSIONS
Elective cholecystectorny after endoscopic common bile duct stone removal is not necessary in patients without gallstones, howevet, one should be aware of possible formation of new stones in the gallbladder and biliary complication.