Risk factors for cholecystectomy in patients with gallbladder stones after endoscopic clearance of common bile duct stones.
BACKGROUND
Cholecystectomy usually is recommended for patients with gallbladder (GB) stones who previously underwent endoscopic removal of common bile duct (CBD) stones. However, in practice, many patients still have GB stones after improvement of their biliary symptoms. This study aimed to evaluate risk factors for cholecystectomy in patients with GB stones after complete endoscopic clearance of CBD stones.


METHODS
From August 2003 to April 2006, the medical data of 61 patients with concomitant GB stones who underwent complete endoscopic clearance of CBD stones were reviewed retrospectively. The risk factors for subsequent cholecystectomy were evaluated during a 24-month of follow-up period.


RESULTS
Among the 61 patients, 12 (19.7%) subsequently required cholecystectomy for recurrence of biliary symptoms, and 11 of these 12 patients (91.7%) needed cholecystectomy within 12 months. Gallbladder stones 10 mm or larger (p = 0.037) and the acute pancreatitis (p = 0.049) were the independent risk factors for subsequent cholecystectomy. The actuarial probability of remaining free of subsequent cholecystectomy during the follow-up period was higher for the patients with GB stones smaller than 10 mm than for the patients with GB stones 10 mm or larger (86.7% vs. 62.5%; p = 0.037). In addition, the patients with acute pancreatitis had a higher tendency for subsequent cholecystectomy than the patients without acute pancreatitis (50% vs. 16.4%; p = 0.078).


CONCLUSIONS
Only a small number of patients subsequently needed to undergo cholecystectomy for recurrence of biliary symptoms, and most events developed within 12 months. For the patients with GB stones 10 mm or larger or acute pancreatitis, prophylactic cholecystectomy is strongly recommended after complete clearance of CBD stones.
Lee
Kang-Moon
KM
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Vincent's Hospital, Ji-dong, Paldal-gu, Suwon-si, Gyeonggi-do, 442-723, South Korea.
Paik
Chang Nyol
CN
Chung
Woo Chul
WC
Kim
Jin Dong
JD
Lee
Cheong Rok
CR
Yang
Jin Mo
JM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000453:epidemiology; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D002764:Cholecystitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003085:Colic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000453:epidemiology / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic; D014463:Ultrasonography; D055815:Young Adult