Su1593 Long-Term Outcome of Endoscopic Transpapillary Gallbladder Drainage: a Single-Center Experience

Abstract

Su1592 Whether a Wait-and-See Policy or Add on Therapy With Choleretics Is Effective in Gallbladder in Situ Without Definite Stones Following Complete Removal of Biliary Stones? a Prospective Multicenter Observational Study Tae Hoon Lee*, Hyun Jong Choi, Joung-Ho Han, Yong Seok Kim, Seok Jeong, Yun Nah Lee, Yunho Jung, Young Sin Cho, Dong Hee Koh, Jong Ho Moon, Sang-Heum Park Internal Medicine, Soonchunhyang University School of Medicine, Cheonan, Korea (the Republic of); Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea (the Republic of); Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea (the Republic of); Internal Medicine, Konyang University School of Medicine, Daejeon, Korea (the Republic of); Internal Medicine, Inha University School of Medicine, Incheon, Korea (the Republic of); Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea (the Republic of) Background/Aims: In patients with acalculous gallbladder in situ after complete removal of common bile duct (CBD) stones, there is no definite guideline for the management of remnant gallbladder. Elective cholecystectomy for acalculous gallbladder following removal of CBD stones is still controversial. We aimed to evaluate whether a wait-and-see policy or add on therapy with choleretics is justified in gallbladder in situ without definite stones following complete removal of CBD stones by ERCP. Patients and Methods: In this prospective comparative study in five tertiary referral centers, patients who underwent therapeutic ERCP to removal of CBD stones were randomized to a group received choleretic agents during 3 months (UDCA 600 mg or Terpene derivatives 300 mg per day) or just wait-and-see group after complete clearance of CBD stones. All patients did not have definite gallstones in gallbladder except sludges. The primary outcome was further developed biliary complications needed cholecystectomy or therapeutic ERCP between an add on therapy group with choleretics and a wait-and-see policy group during long-term observational period. Results: Two hundred eighteen patients entered into the trial; 110 of 218 patients were randomized to a choleretics medication group and others were randomized to a just wait-and-see group after complete removal of CBD stones by ERCP. Number of CBD stones, CBD dilatation, and mean sessions of ERCP for complete CBD clearance were not different between two groups. There was no definite gallbladder stones in both group, but gallbladder sludges were detected in 30 (27.3%) and 22 (20.4%) patients, respectively (PZ0.232). Median follow-up was 701 days (range, 105-1523) in choleretics medication group and 565 days (93-1229) in a wait-and-see group, respectively. During a median follow-up of approximately 2 years, recurrent biliary events needed surgical cholecystectomy or therapeutic ERCP were not different statistically (PZ0.376). Eleven patients (10%) in choleretics medication group returned with further biliary events (cholecystitis needed cholecystectomy, nZ2; cholangitis needed ERCP, nZ9). Among those with wait-and-see group, 15 (13.9%) returned with further biliary events (cholecystitis needed cholecystectomy, nZ2; cholangitis needed ERCP, nZ13). There was no cholereticsrelated complications needed additional therapy or withdraw. Median biliary eventsfree survival was also not different between two groups (636 vs. 402 days, Log-rank PZ0.066). Conclusions: During observational period, biliary complications needed operation or therapeutic ERCP were more frequent in a wait-and-see group without statistical difference. More long-term follow up is required to distinguish the statistical difference.