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- Title
Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 13.
- Authors
Barkun, Jeffrey; Dixon, Elijah; Strasberg, Steven
- Abstract
Question: Is a wait-and-see policy better than a cholecystectomy within 6 weeks after endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and clearance of the common bile duct of stones? Design: Randomized controlled trial. Setting: A multicentre trial that included 1 academic centre and 8 community hospitals in The Netherlands. Patients: One hundred and twenty patients with proven gallbladder stones who underwent endoscopic sphincterotomy and stone extraction. Intervention: Patients were randomly allocated using a computer generated randomization scheme by an independent trial bureau to either a wait-and-see approach (n = 64) or laparoscopic cholecystecomy (n = 56). Outcome measure: At least 1 biliary event during a 2-year followup. Results: Twelve patients were lost to follow-up immediately. Of the 59 patients randomized to a wait and- see approach (and available for analysis), 27 (46%) had recurrent biliary symptoms versus 1 (2%) of 49 patients after laparoscopic cholecystectomy (LC) (risk ratio = 22.42, 95% confidence interval [CI] 3.16-159.14, p < 0.001). Twenty-two (81%) of the 27 wait-and-see patients underwent cholecystectomy, mainly for biliary pain (13 patients) or acute cholecystitis (7 patients). The rate of conversion to open cholecystectomy was 55% in patients allocated to the wait-and-see group compared with 23% for those who underwent immediate LC (p = 0.010). Conclusion: A wait-and-see policy after endoscopic sphincterotomy should not be recommended as the standard treatment since 46% had at least 1 more biliary event and 37% required cholecystectomy.
- Subjects
CHOLECYSTECTOMY; GALLBLADDER surgery; ENDOSCOPIC retrograde cholangiopancreatography; SURGEONS; BILIARY tract radiography; BILE ducts
- Publication
Canadian Journal of Surgery, 2005, Vol 48, Issue 3, p244
- ISSN
0008-428X
- Publication type
Article