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Clinical Question:
Does prophylactic cholecystectomy is beneficial in patients with small
gallstone?
Bottom Line:
Small gallstones are associated with pancreatitis. Prophylactic
cholecystectomy may lead to gain or loss of life-years in patients with
small stones, depending on incidence and mortality of pancreatitis.
Reference:
Small gallstones are associated with increased risk of acute pancreatitis:
potential benefits of prophylactic cholecystectomy?Venneman NG, Buskens E,
Besselink MG, Stads S, Go PM, Bosscha K, van Berge-Henegouwen GP, van
Erpecum KJ.Am J Gastroenterol. 2005 Nov;100(11):2540-50
Synopsis:
Pancreatitis is a severe complication of gallstone disease with considerable
mortality. Small gallstones may increase the risk of pancreatitis. Our aims
were to evaluate potential association of small stones with pancreatitis and
potential beneficial effects of prophylactic cholecystectomy. Stone
characteristics were determined in patients with biliary pancreatitis (115),
obstructive jaundice due to gallstones (103), acute cholecystitis (79), or
uncomplicated gallstone disease (231). Sizes and numbers of gallbladder and
bile duct stones were determined by ultrasonography and endoscopic
retrograde cholangiopancreatography, respectively. Effects of prophylactic
cholecystectomy were assessed by decision analyses with a Markov model and
Monte Carlo simulations. Patients with pancreatitis or obstructive jaundice
had more and smaller gallbladder stones than those with acute cholecystitis
or uncomplicated disease (diameters of smallest stones: 3 +/- 1, 4 +/- 1, 8
+/- 1, and 9 +/- 1 mm, respectively, p < 0.01). Bile duct stones were
smaller in case of pancreatitis than in obstructive jaundice (diameters of
smallest stones: 4 +/- 1 vs 8 +/- 1, p < 0.01). Multivariate analysis
identified old age and small stones as independent risk factors for
pancreatitis. Decision analysis in a representative group of patients with
small (<or=5 mm) gallstones (5,000 patients, 67% females, 45 yr old, 10-yr
follow-up) indicates that life-years may be gained or lost by
cholecystectomy, depending on incidence and mortality of pancreatitis. |