Korean J Intern Med.  2001 Dec;16(4):254-259.

Is Cholecystectomy Necessary After ERCP for Bile Duct Stones in Patients with Gallbladder in situ?

• Kwon SK
• Lee BS
• Kim NJ
• Lee HY
• Chae HB
• Youn SJ
• Park SM

Abstract

BACKGROUND
The requirement for subsequent cholecystectomy in patients with gallbladder in situ after endoscopic removal of stones from the common bile duct (CBD) is controversial. The aims of this study were to assess the requirement for subsequent cholecystectomy for gallbladder-related symptoms, and to identify the patients who develop symptoms after the endoscopic removal of CBD stones.
METHODS
Of 241 patients with gallbladder in situ following endoscopic removal of stones from the CBD, 146 patients (78 men and 68 women; mean age 69+/-13 years, range 20-93) with a follow-up time of more than three months without elective cholecystectomy were enrolled in the study. Fifty-nine patients had gallbladder stones (single stones in 27 and multiple stones in 32) and 87 patients had gallbladder in situ without stones. The time from entry to the occurrences of death or cholecystectomy was evaluated retrospectively. Cox regression analysis was used to evaluate the risk factors associated with these events.
RESULTS
The mean duration of follow-up was 24.1+/-18.0 months (range 3-70 months). During follow-up, seven patients (4.8%) underwent cholecystectomy, on average 18.4 months after CBD stone removal, as the result of acute cholecystitis in four cases, biliary pain in two cases and acute pancreatitis in one case. Laparoscopic cholecystectomy was performed in four patients and open cholecystectomy in three patients. Post-operative morbidity occurred in two patients, with improvement after conservative management. Nine patients (6.2%) died as the result of unrelated biliary disease. Age, sex, presence of gallbladder stones, multiplicity of gallbladder stones and underlying disease did not correlate with subsequent cholecystectomy by Cox regression analysis.
CONCLUSION
Elective cholecystectomy is not warranted in patients with bile duct stones when the common duct can be cleared of stones by endoscopic sphincterotomy. We could not find any clinical predictors of further symptoms or complications arising from the retained gallbladder.

Keyword

Gallbladder in situ; cholecystectomy; common bile duct calculi; Sphincterotomy; endoscopic

MeSH Terms

Adult
Aged
Aged, 80 and over
Analysis of Variance
Chi-Square Distribution
Cholangiopancreatography, Endoscopic Retrograde
*Cholecystectomy
Common Bile Duct Calculi/*surgery
Female
Gallbladder/*surgery
Human
Male
Middle Age
Regression Analysis
Retrospective Studies
Risk Factors
Sphincterotomy, Endoscopic
Surgical Procedures, Elective