title: The Impact of Gallbladder Status on Biliary Complications After the Endoscopic Removal of Choledocholithiasis.
abstract: BACKGROUND
  Endoscopic sphincterotomy (EST) with stone extraction is the standard management for choledocholithiasis. However, the necessity for subsequent management of gallstone to prevent the biliary complications remained controversial and few data were evaluated for the impact of status of gallbladder on recurrent biliary complications. We retrospectively investigated the relationship between the status of gallbladder and the occurrence of biliary complications after endoscopic removal of choledocholithiasis.
  
  
  METHODS
  Between January 1998 and December 2008, we enrolled 453 patients with intact gallbladder who underwent EST for choledocholithiasis and allocated into two groups: calculous gallbladder (n = 256) and acalculous gallbladder (n = 197). By reviewing patients' medical records, we compared the occurrence of biliary complications according to the presence or absence of gallstone in GB in situ.
  
  
  RESULTS
  In total, biliary complications occurred in 83 patients (18.3 %) during the follow-up period. Calculous GB group had higher rate of overall complications (22.7 vs. 12.7 %; p = 0.007) and GB-associated complications (11.3 vs. 2.5 %; p = 0.001) than acalculous GB group. On the multivariate analysis, only the presence of gallstone was shown to be significant risk factor for overall biliary complication (OR 2.029; 95 % CI 1.209-3.405; p = 0.007) and GB-associated complications (OR 5.077; 95 % CI 1.917-13.446; p = 0.001). Mean event-free period was shorter in calculous GB group than acalculous GB group for overall complications (1774 vs. 2159 days; p = 0.012) and GB-associated complication (2153 vs. 2591 days; p = 0.001).
  
  
  CONCLUSIONS
  Prophylactic cholecystectomy may not be necessary to prevent biliary complication in patients with acalculous gallbladder after endoscopic removal of pigment stones from bile duct.
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, 807 Hokuk-Ro, Buk-Gu, Daegu, 702-911, South Korea.
authors.forename: Myung Hi
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, 807 Hokuk-Ro, Buk-Gu, Daegu, 702-911, South Korea.
authors.forename: Seong Jae
authors.initials: SJ
authors.lastname: Yeo
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, 807 Hokuk-Ro, Buk-Gu, Daegu, 702-911, South Korea.
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Kyungpook National University Hospital, 807 Hokuk-Ro, Buk-Gu, Daegu, 702-911, South Korea. cmcho@knu.ac.kr.
authors.forename: Chang Min
authors.identifier: http://orcid.org/0000-0002-9903-1282
authors.initials: CM
authors.lastname: Cho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D042883:Choledocholithiasis / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Biliary complications; Choledocholithiasis; GB stone; Prophylactic cholecystectomy