Intervention versus surveillance in patients with common bile duct stones detected by intraoperative cholangiography: a population-based registry study.
Adult
Aged
Aged, 80 and over
Asymptomatic Diseases
Cholangiography
Cholangiopancreatography, Endoscopic Retrograde
/ statistics & numerical data
Cholecystectomy
Choledocholithiasis
/ diagnostic imaging
Female
Humans
Intraoperative Care
Male
Middle Aged
Registries
Retrospective Studies
Sweden
/ epidemiology
Watchful Waiting
Young Adult
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
received:
25
04
2021
accepted:
26
08
2021
pubmed:
14
10
2021
medline:
4
1
2022
entrez:
13
10
2021
Statut:
ppublish
Résumé
Each year 13 000 patients undergo cholecystectomy in Sweden, and routine intraoperative cholangiography (IOC) is recommended to minimize bile duct injuries. The risk of requiring endoscopic retrograde cholangiopancreatography (ERCP) following cholecystectomy for common bile duct (CBD) stones where IOC is omitted and in patients with CBD stones left in situ is not well known. Data were retrieved from the population-based Swedish Registry of Gallstone Surgery and ERCP between 1 January 2009 and 10 December 2019. Primary outcome was risk for postoperative ERCP for retained CBD stones. A total of 134 419 patients that underwent cholecystectomy were included and 2691 (2.0 per cent) subsequently underwent ERCP for retained CBD stones. When adjusting for emergency or planned cholecystectomy, preoperative symptoms suggestive of CBD stones, sex and age, there was an increased risk for ERCP when IOC was not performed (hazard ratio (HR) 1.4, 95 per cent c.i. 1.3 to 1.6). The adjusted risk for ERCP was also increased if CBD stones identified by IOC were managed with surveillance (HR 5.5, 95 per cent c.i. 4.8 to 6.4). Even for asymptomatic small stones (less than 4 mm), the adjusted risk for ERCP was increased in the surveillance group compared with the intervention group (HR 3.5, 95 per cent c.i. 2.4 to 5.1). IOC plus an intervention to remove CBD stones identified during cholecystectomy was associated with reduced risk for retained stones and unplanned ERCP, even for the smallest asymptomatic CBD stones. This population-based registry study shows that when common bile duct (CBD) stones are identified by intraoperative cholangiography (IOC) and not removed, there is a risk for retained stones requiring endoscopic retrograde cholangiopancreatography. For asymptomatic stones less than 4 mm diameter, 10.7 per cent in the surveillance group had a retained stone following surgery. These findings imply that even the smallest CBD stones identified by IOC should be removed.
Sections du résumé
BACKGROUND
Each year 13 000 patients undergo cholecystectomy in Sweden, and routine intraoperative cholangiography (IOC) is recommended to minimize bile duct injuries. The risk of requiring endoscopic retrograde cholangiopancreatography (ERCP) following cholecystectomy for common bile duct (CBD) stones where IOC is omitted and in patients with CBD stones left in situ is not well known.
METHODS
Data were retrieved from the population-based Swedish Registry of Gallstone Surgery and ERCP between 1 January 2009 and 10 December 2019. Primary outcome was risk for postoperative ERCP for retained CBD stones.
RESULTS
A total of 134 419 patients that underwent cholecystectomy were included and 2691 (2.0 per cent) subsequently underwent ERCP for retained CBD stones. When adjusting for emergency or planned cholecystectomy, preoperative symptoms suggestive of CBD stones, sex and age, there was an increased risk for ERCP when IOC was not performed (hazard ratio (HR) 1.4, 95 per cent c.i. 1.3 to 1.6). The adjusted risk for ERCP was also increased if CBD stones identified by IOC were managed with surveillance (HR 5.5, 95 per cent c.i. 4.8 to 6.4). Even for asymptomatic small stones (less than 4 mm), the adjusted risk for ERCP was increased in the surveillance group compared with the intervention group (HR 3.5, 95 per cent c.i. 2.4 to 5.1).
CONCLUSION
IOC plus an intervention to remove CBD stones identified during cholecystectomy was associated with reduced risk for retained stones and unplanned ERCP, even for the smallest asymptomatic CBD stones.
This population-based registry study shows that when common bile duct (CBD) stones are identified by intraoperative cholangiography (IOC) and not removed, there is a risk for retained stones requiring endoscopic retrograde cholangiopancreatography. For asymptomatic stones less than 4 mm diameter, 10.7 per cent in the surveillance group had a retained stone following surgery. These findings imply that even the smallest CBD stones identified by IOC should be removed.
Autres résumés
Type: plain-language-summary
(eng)
This population-based registry study shows that when common bile duct (CBD) stones are identified by intraoperative cholangiography (IOC) and not removed, there is a risk for retained stones requiring endoscopic retrograde cholangiopancreatography. For asymptomatic stones less than 4 mm diameter, 10.7 per cent in the surveillance group had a retained stone following surgery. These findings imply that even the smallest CBD stones identified by IOC should be removed.
Identifiants
pubmed: 34642735
pii: 6395095
doi: 10.1093/bjs/znab324
pmc: PMC10364905
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1506-1512Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
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