Kolelitiazis Olmadan Gelişen Koledokolitiazis Hastalarının Endoskopik Retrograd Kolanjiopankreatografi Sonrası Kolesistektomisiz Takibi

Abstract

Amaç: Görüntüleme yöntemlerinin yaygın kullanılması kolelitiazis ve koledokolitiazis tanısını ve görülme sıklığı artırmaktadır.Buna karşılık, bu yaygın hastalığın yönetiminde cevap gerektiren bazı sorular vardır.

Gereç Ve Yöntem: Şubat 2014 ile Ocak 2018 arasındaki dönemde kurumumuzda endoskopik retrograd kolanjiopankreatografi (ERCP) yapılan hastaların verileri prospektif olarak toplandı ve retroprospektif olarak analiz edildi. Çalışmaya safra kesesinde (SK) taş olmayıp koledokta taşı olan 52 hasta dâhil edildi. Safra kesesinin değerlendirilmesi ise abdomen USG ile gerçekleştirildi. ERCP, laparoskopik kolesistektomi ve hasta takibi tek cerrah tarafından gerçekleştirildi.

Bulgular: Çalışmaya dâhil edilen SK taşı olmadan koledok taşı olan hastaların (grup A) yaş ortalaması 64.83 ± 17.06 olup bunlardan 23 (%44,2 ) i <65 yaş altında ve 29 (%55,8 ) ≥65yaşından yaşlı idi. Diğer nedenlerle ERCP yapılan hastalar grup B olarak belirlendi. Grup A hastalarında yaş ortalaması grup B ye göre anlamlı olarak daha yüksek bulundu (P=0.001). Dört hastaya safra kesesinde tekrar taş oluşumu nedeniyle ve üç hastaya erken dönemde gelişen akut kolesistit nedeniyle laparoskopik kolesistektomi gerçekleştirildi. Ulaşılamayan ve takip kriterlerine uymayan hastalar çalışmadan çıkarıldı, kalan 30 hastanın rutin poliklinik ziyaretlerinde (4-24 ay takip) safra kesesinde taş tespit edilemedi ve rutin poliklinik kontrollerinin devamı önerildi.

Sonuç: Safra kesesinde taşı olmayıp sekonder veya primer koledok taşı olan hastalarda, ERCP ile taş safra kanalından çıkarıldıktan sonra asemtomatik ve fonksiyonel safra kesesi olan hastalar kolesistektomi yapılmadan takip edilebilir.

Keywords

• safra kesesi
• kolelitiasis
• laparoskopik kolesistektomi

Choledocholithiasis without cholecystolithiasis, after endoscopic retrograde cholangiopancreatography follow-up without cholecystectomy

Abstract

Objective: The widespread use of imaging methods increases the diagnosis and incidence of cholelithiasis. In recent years, the management of patients with cholelithiasis has improved significantly owing to significant advances in the surgical and endoscopic intervention.

Materials and Methods: Between February 2015 and January 2018, the data of patients who underwent ERCP at our institution were collected prospectively and analyzed retrospectively. Forty-four patients included in the study were patients with choledocholithiasis without stones in the GB.

Results: The mean age of 52 subjects (group A) included in the study was 64.83 ± 17.06, of which 23 (44.2%) were <65 years old and 29 (55.8%) were ≥65 years old. Twenty-four (46.2%) women and twenty-eight (53.8%) men were included in the study. Malignancy was suspected in 6 (11.5%) patients and no suspicion of malignancy was confirmed after Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedure. In group A, 14 patients (26.9%) required a second ERCP, while in group B, the number of patients requiring a second ERCP was 163 (21.3%). The mean length of hospital stay in group A and group B patients was 5.29 ± 3.38 and 6.29 ± 5.39, respectively, and the average cost was 474 $ ± 286 $ and 564 $ ± 664 $, respectively, with no statistical difference between the groups.

Conclusions: In conclusion, we think that in patients with secondary or primary choledochal stones without gallstones and with functional GB might be following up without cholecystectomy after the stone is removed from the bile duct by ERCP

Keywords

• Gallbladder
• Laparoscopic Cholecystectomy
• cholelithiasis

References

1. REFERENCES
2. 1. Molvar C, Glaenzer B.Evaluation, Treatment, and Outcomes.Semin Intervent Radiol. 2016 Dec;33(4):268-276.
3. 2. European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice. eu, EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones.J Hepatol.2016;65(1):146–181.
4. 3. R Costi, A Gnocchi, FDi Mario, and L Sarli. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol. 2014 Oct 7; 20(37): 13382–13401.
5. 4. James Y.W. Lau, Yuk Tong Lee, and Joseph Sung. Chapter 43. Choledocholithiasis, Section III—Approach to Clinical Problems. Press: 2015. p. 410-418. Available from: http://blog.utp.edu.co/cirugia/files/2011/07/coledocolitiasis-2015.pdf
6. 5. Tan YY, Zhao G, Wang D, Wang JM, Tang JR, Ji ZL.A new strategy of minimally invasive surgery for cholecystolithiasis: calculi removal and gallbladder preservation.Dig Surg. 2013;30(4-6):466-71.
7. 6. G Watanabe, M Hashimoto, M Matsuda, Evaluation of 'New classification of Japanese gallbladder stones (1986)' with chemical componential analysis, Tando, 2017, Volume 31, Issue 2, Pages 205-213, Released June 07, 2017, Online ISSN 1883-6879, Print ISSN 0914-0077.
8. 7. Gregory A. Bortoff, Michael Y. M. Chen et al. Gallbladder Stones: Imaging and Intervention. Vol. 20, No. 3 Published Online: May 1 2000https://doi.org/10.1148/radiographics.20.3.g00ma16751

9. 8. Marilee L Freitas, Robert L Bell, and Andrew J Duffy. Evolving standards for diagnosis and management.World J Gastroenterol. 2006 May 28; 12(20): 3162–3167.
10. 9. Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, Tsai WW. et al.Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med.1994;5(22):2573–2581.
11. 10. Pinto A, Reginelli A, Cagini L, Coppolino F, Stabile Ianora AA, Bracale R et al. Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature.Crit Ultrasound J. 2013 Jul 15;5 Suppl 1:S11.
12. 11. Grantcharov TP, Rasti Z, Rossen B, Kristiansen VB, Rosenberg J. Interobserver agreement in ultrasound examination of the biliary tract. Acta Radiol.2002;5(1):77–79
13. 12. Malay Sharma, Piyush Somani, and Tagore Sunkara.Imaging of gall bladder by endoscopic ultrasound.World J Gastrointest Endosc. 2018 Jan 16; 10(1): 10–15.Published online 2018 Jan 16. doi: 10.4253/wjge.v10.i1.10
14. 13. Freitas ML , Bell RL, Duffy AJ.evolving standards for diagnosis and management.World J Gastroenterol. 2006 May 28;12(20):3162-7
15. 14. Pritesh Mutha Email ,Tilak ShahDouglas, HeumanAlvin et al. Choledocholithiasis Without Cholelithiasis: Should the Gallbladder Stay or Should It Go?Digestive Diseases and Sciences April 2016, Volume 61, Issue 4, pp 961–962
16. 15. 15 Altieri MS, Brunt LM, Yang J, Zhu C, Talamini MA, Pryor AD.arly cholecystectomy (< 72 h) is associated with lower rate of complications and bile duct injury: a study of 109,862 cholecystectomies in the state of New York.Surg Endosc. 2019 Aug 2.
17. 16. Terauchi T, Shinozaki H, Shinozaki S, Sasakura Y etal. Single-Stage Endoscopic Stone Extraction and Cholecystectomy during the Same Hospitalization.Clin Endosc. 2019 Jan;52(1):59-64. 17. Bahtiyar M. Single-stage treatment with ERCP and laparoscopic cholecystectomy versus two-stage treatment with ERCP followed by laparoscopic cholecystectomy within 6 to 8 weeks: A retrospective study. Turk J Surg. 2019 Sep;35(3): 178–184.
18. 18. García Ontiveros A, Cantero Hinojosa J, Gil Extremera B, Miñarro del Moral J. Differences in gallstone structure in primary common bile duct lithiasis and gallbladder lithiasis. Klin Wochenschr. 1990 May 17;68(10):496-502.
19. 19. Kaufman HS, Magnuson TH, Lillemoe KD, Frasca P, Pitt HA. The role of bacteria in gallbladder and common duct stone formation. Ann Surg. 1989 May;209(5):584-91; discussion 591-2.
20. 20. Tan YY, Zhao G, Wang D, Wang JM,Tang JR,Ji ZL. A new strategy of minimally invasive surgery for cholecystolithiasis: calculi removal and gallbladder preservation. Dig Surg. 2013;30(4-6):466-71.
21. 21. De -Kang Gao, Shao-Hua Wei, Wei Li Jie Ren et al. Totally laparoscopic gallbladder-preserving surgery: A minimally invasive and favorable approach for cholelithiasis.Exp Ther Med. 2015 Feb; 9(2): 395–398.
22. 22. Hakan Akıncı. Laparoscopic gallbladder-preserving surgery: Case report. Laparosc Endosc Surg Sci 2019;26(1):32-35
23. 23. Ming-Guo Tian, Wei-Jin Shi, Xin-Yuan Wen, Hai-Wen Yu at al.Outcome of gallbladder preservation in surgical management of primary bile duct stones.World J Gastroenterol. 2003 Aug 15; 9(8): 1871–1873