Abstract
sBackgroundIn patients with common bile duct stones (CBDS) and intact gallbladder, further management for the gallbladder after the CBDS clearance is still controversial. The relationship between gallbladder motility and the biliary complications were seldom discussed. Our study is to predict the subsequent biliary complications by gallbladder function test using fatty meal sonography (FMS) in patients with CBDS who had been treated by endoscopic retrograde cholangiopancreatography (ERCP).MethodsPatients with an intact gallbladder and CBDS after endoscopic clearance of bile duct were enrolled. Patients received a fatty meal sonography after liver function returned to normal. The fasting volume, residual volume, and gallbladder ejection fraction (GBEF) in FMS were measured. Relationships of patients’ characteristics, gallbladder function and recurrent biliary complication were analyzed.ResultsFrom 2011 to 2014, 118 patients were enrolled; 86 patients had calculus gallbladders, and 32 patients had acalculous gallbladders. After a mean follow- up of 33 months, 23 patients had recurrent biliary complications. Among 86 patients with calculus gallbladder, 15 patients had spontaneous clearance of gallbladder stones; 14 patients received cholecystectomy due to acute cholecystitis or recurrent colic pain with smooth postoperative courses. In the follow up period, six patients died of non-biliary causes. The GBEF is significant reduced in most patients with a calculus gallbladder in spite of stone color. Calculus gallbladder, alcohol drinking and more than one sessions of initial endoscopic treatment were found to be the risk factors of recurrent biliary complication.ConclusionsGallbladder motility function was poorer in patients with a calculus gallbladder, but it cannot predict the recurrent biliary complication. Since spontaneous clearance of gallbladder stone may occur, wait and see policy of gallbladder management after endoscopic treatment of CBDS is appropriate, but regular follow- up in those patients with risk factors for recurrence is necessary.
Highlights
In patients with common bile duct stones (CBDS) and intact gallbladder, further management for the gallbladder after the CBDS clearance is still controversial
The gallbladder ejection fraction (GBEF) is significant reduced in most patients with a calculus gallbladder in spite of stone color
Gallbladder motility function was poorer in patients with a calculus gallbladder, but it cannot predict the recurrent biliary complication
Summary
In patients with common bile duct stones (CBDS) and intact gallbladder, further management for the gallbladder after the CBDS clearance is still controversial. The relationship between gallbladder motility and the biliary complications were seldom discussed. In patients with CBDS and an intact gallbladder, the management of the gallbladder after endoscopic clearance of the bile duct is controversial. Some studies suggest that elective cholecystectomy after endoscopic clearance of CBDS may reduce the late biliary complications [3,4,5], but other studies have not confirmed the same benefits [6,7,8]. Patients with calculus gallbladder exhibited a higher incidence of an overall delayed biliary complications than those with acalculous gallbladder and cholecystectomy both before and after endoscopic treatment for CBDS. The relationship between gallbladder status, motility and recurrent biliary complications after endoscopic treatment has seldom been discussed
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