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Article: Management of gallstone cholangitis in the era of laparoscopic cholecystectomy

TitleManagement of gallstone cholangitis in the era of laparoscopic cholecystectomy
Authors
Issue Date2001
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2001, v. 136 n. 1, p. 11-16 How to Cite?
AbstractHypothesis: The combined endoscopic and laparoscopic approach is safe and effective in managing gallstone cholangitis in the era of laparoscopic cholecystectomy (LC). Design: Retrospective case series. Setting: University teaching hospital. Patients: One hundred eighty-four consecutive patients with gallstone cholangitis treated between January 1995 and December 1998. Interventions: The main treatments were endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval LC. Open or laparoscopic common bile duct exploration (OCBDE or LCBDE) was used when ERCP or ES failed. Main Outcome Measures: Success of various interventions, morbidity and mortality, and long-term incidence of recurrent biliary symptoms. Results: Endoscopic retrograde cholangiopancreatography was successful in 175 patients (95%), with bile duct stones found in 147 (84%). Endoscopic stone clearance by ES was achieved in 132 patients (90%). Morbidity rate after ERCP or ES was 4.0% (n=7), and overall mortality rate from cholangitis was 1.6% (n=3). After bile duct stone clearance, 82 patients underwent LC with a conversion rate of 9.8% (n=8) and a morbidity rate of 3.6% (n=3). Eighteen patients underwent OCBDE with a morbidity rate of 33% (n=6), and 3 underwent LCBDE with 1 conversion and no morbidity. There was no operative mortality. Seventy-eight patients were managed conservatively after endoscopic clearance of bile duct stones. Follow-up data were available in 101 patients with cholecystectomy and 73 patients with gallbladder in situ. During a median follow-up of 24 months, recurrent biliary symptoms occurred in 5.9% (n=6) and 25% (n=18), respectively (P=.001). In both groups, the most common recurrent symptom was cholangitis (n=5 and n=14, respectively). Gallbladder in situ (risk ratio, 4.16; 95% confidence interval, 1.39-12.50; P=.01) and small-size papillotomy (risk ratio, 2.94; 95% confidence interval, 1.07-8.10; P=.04) were significant risk factors for recurrent biliary symptoms. Conclusions: Endoscopic sphincterotomy for biliary drainage and stone removal, followed by interval LC, is a safe and effective approach for managing gallstone cholangitis. Patients with gallbladder left in situ after ES have an increased risk of recurrent biliary symptoms. Laparoscopic cholescystectomy should be recommended after endoscopic management of cholangitis except in patients with prohibitive surgical risk.
Persistent Identifierhttp://hdl.handle.net/10722/83625
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPoon, RTPen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLam, CMen_HK
dc.contributor.authorYuen, WKen_HK
dc.contributor.authorYeung, Cen_HK
dc.contributor.authorFan, STen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:43:15Z-
dc.date.available2010-09-06T08:43:15Z-
dc.date.issued2001en_HK
dc.identifier.citationArchives Of Surgery, 2001, v. 136 n. 1, p. 11-16en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/83625-
dc.description.abstractHypothesis: The combined endoscopic and laparoscopic approach is safe and effective in managing gallstone cholangitis in the era of laparoscopic cholecystectomy (LC). Design: Retrospective case series. Setting: University teaching hospital. Patients: One hundred eighty-four consecutive patients with gallstone cholangitis treated between January 1995 and December 1998. Interventions: The main treatments were endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval LC. Open or laparoscopic common bile duct exploration (OCBDE or LCBDE) was used when ERCP or ES failed. Main Outcome Measures: Success of various interventions, morbidity and mortality, and long-term incidence of recurrent biliary symptoms. Results: Endoscopic retrograde cholangiopancreatography was successful in 175 patients (95%), with bile duct stones found in 147 (84%). Endoscopic stone clearance by ES was achieved in 132 patients (90%). Morbidity rate after ERCP or ES was 4.0% (n=7), and overall mortality rate from cholangitis was 1.6% (n=3). After bile duct stone clearance, 82 patients underwent LC with a conversion rate of 9.8% (n=8) and a morbidity rate of 3.6% (n=3). Eighteen patients underwent OCBDE with a morbidity rate of 33% (n=6), and 3 underwent LCBDE with 1 conversion and no morbidity. There was no operative mortality. Seventy-eight patients were managed conservatively after endoscopic clearance of bile duct stones. Follow-up data were available in 101 patients with cholecystectomy and 73 patients with gallbladder in situ. During a median follow-up of 24 months, recurrent biliary symptoms occurred in 5.9% (n=6) and 25% (n=18), respectively (P=.001). In both groups, the most common recurrent symptom was cholangitis (n=5 and n=14, respectively). Gallbladder in situ (risk ratio, 4.16; 95% confidence interval, 1.39-12.50; P=.01) and small-size papillotomy (risk ratio, 2.94; 95% confidence interval, 1.07-8.10; P=.04) were significant risk factors for recurrent biliary symptoms. Conclusions: Endoscopic sphincterotomy for biliary drainage and stone removal, followed by interval LC, is a safe and effective approach for managing gallstone cholangitis. Patients with gallbladder left in situ after ES have an increased risk of recurrent biliary symptoms. Laparoscopic cholescystectomy should be recommended after endoscopic management of cholangitis except in patients with prohibitive surgical risk.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.titleManagement of gallstone cholangitis in the era of laparoscopic cholecystectomyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=136&spage=11&epage=16&date=2001&atitle=Management+of+gallstone+cholangitis+in+the+era+of+laparoscopic+cholecystectomyen_HK
dc.identifier.emailPoon, RTP: poontp@hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityPoon, RTP=rp00446en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid11146767-
dc.identifier.scopuseid_2-s2.0-0035154349en_HK
dc.identifier.hkuros59011en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0035154349&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume136en_HK
dc.identifier.issue1en_HK
dc.identifier.spage11en_HK
dc.identifier.epage16en_HK
dc.identifier.isiWOS:000166307500001-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridPoon, RTP=7103097223en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLam, CM=36799183200en_HK
dc.identifier.scopusauthoridYuen, WK=36849206000en_HK
dc.identifier.scopusauthoridYeung, C=26531966700en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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