Incidence Of Gallstone Disease Research Articles

Жовчнокам'яна хвороба в дітей

The prevalence of gallstone disease among children is 0.13-1.9%. Cholelithiasis in children is a multifactorial disorder. Scientific data analysis indicates a diversity of pathogenetic mechanism of gallstone formation. The purpose of the review is to summarize the scientific data about risk factors, clinical features, diagnosis and treatment of gallstone disease in children. Based on the literature data, the main factors for the disease are genetic, metabolic, low-calorie diet, nutritional disorders, liver and small intestine diseases. The main pathogenetic mechanisms of gallstone formation are liver dyscholia, disorders of enterohepatic circulation of bile acids, increased erythrocyte hemolysis and erythrocyte enzyme system insufficiency, a decrease in hepatic enzyme activity, impairment of gallbladder motility due to decreased sensitivity to cholecystokinin. Most children undergo asymptomatic gallstone disease: clinical features are absent, concrements in the gallbladder or bile ducts appear as accidental findings during ultrasound examination. The first stage of diagnosing cholelithiasis is an abdominal ultrasound examination. In case of absence of concrements during ultrasound examination and presence of typical clinical picture of cholelithiasis, endoscopic ultrasound and magnetic resonance cholangiopancreatography are prescribed. To reduce biliary pain, non-steroidal anti-inflammatory drugs and analgesics are required. The only way to treat symptomatic form of gallstone disease is cholecystectomy. The asymptomatic form is subject to observation without treatment. For the treatment and prevention of cholelithiasis, it is not recommended to take bile acid preparations due to the low effectiveness and frequency of relapses in the formation of stones after their complete dissolution. Conclusions. The incidence of gallstone disease among children and adolescents increases and more than half of patients has asymptomatic form. During the treatment of patients with cholelithiasis, cholecystectomy or observation tactics are used, depending on the clinical form of the disease. Prevention of gallstone disease relies on healthy lifestyle, weight loss for the obese children, physical activity, diet high in fiber and calcium. The authors declare that they have no conflicts of interest.

Laparoscopic Removal of a Giant Gallstone in UAE: A Case Report

Background: Diseases of the gallbladder (GB) are a common occurrence, and gallstones are the most common biliary pathology. Lately, the incidence of gallstone disease has been on the rise in the United Arab Emirates (UAE). Case-Report: We present a case report of a 52 years old female who presented with severe upper abdominal pain. The clinical examination and ultrasound imaging were consistent with the calculus of the gallbladder with acute cholecystitis without obstruction. Laparoscopic cholecystectomy (LC) was performed to remove a gallstone of 6.8 cm in size. This was performed uneventfully. Discussion: The prevalence of gallstones ranges from 0.1% to 50.5 % worldwide. Gallstones more than 5 cm in diameter are not seen often. LC is quite challenging in such cases. This case report is being presented due to the limited availability of literature on the Laparoscopic removal of giant gallstones in the UAE. Conclusion: Our aim here is to convey that LC can be considered the first choice vis-a-vis open method even in giant gallstone cases in the presence of trained personnel and equipped settings. The epigastric port can be extended for extracting the gallbladder specimen. Open cholecystectomy is a safe method if clear delineation of anatomy is not possible.

CORRELATION OF PRE OPERATIVE AND INTRA OPERATIVE FINDINGS IN GALL STONE DISEASE

Background: Gallstone disease (GD) is a chronic recurrent hepatobiliary disease, the basis for which is the impaired metabolism of cholesterol, bilirubin and bile acids which is characterized by the formation of gallstones in the hepatic bile duct, common bile duct or gallbladder. GD is one of the most prevalent gastrointestinal diseases with a substantial burden to health care systems. GD can result in serious outcomes such as acute gallstone pancreatitis and gallbladder cancer. The epidemiology, correlation with USG ndings and anatomical variants encountered during cholecystectomy are discussed in this study. To compare preoperative and intraope Aims and objectives: rative ndings of gall stone disease in patients who underwent cholecystectomy. 104 patients who underwent cholecystect Materials and methods: omy in Kanyakumari Government Medical College from January 2019 to December 2022. Majority of the patients were Results: in age group between 19 to 78 years of age with a mean age of 42.5. Female predominance was reported in our study comprising 65% of total study participants. The study identied a sensitivity of 0.84 and a specicity of 1 for ultrasound in the identication of gallstones.10 % of the study population had different anatomical variants which were encountered during cholecystectomy. <4% of study population was intraoperatively converted from laparoscopic to open cholecystectomy. 78% of stones are pigment stones based on dry weight analysis. Reproductive Age and fe Summary: male sex are profoundly associated with the incidence of gallstone disease. This study suggests that despite an evolution in the resolution of ultrasound imaging, there has not been a corresponding improvement in sensitivity. Knowledge of Variation in cystic duct anatomy is important to avoid inadvertent injury to the biliary tree during Cholecystectomy. The study population have a predominance of pigment stones based on dry weight analysis

The Etiology of Cholelithiasis in Children and Adolescents-A Literature Review.

The incidence of gallstone disease has increased in recent years. The pathogenesis of cholelithiasis is not fully understood. The occurrence of the disease is influenced by both genetic and environmental factors. This article reviews the literature on cholelithiasis in children, with the exception of articles on hematological causes of cholelithiasis and cholelithiasis surgery. The aim of this review is to present the latest research on the pathogenesis of gallstone disease in children. The paper discusses the influence of all factors known so far, such as genetic predisposition, age, infections, medications used, parenteral nutrition, and comorbidities, on the development of gallstone disease. The course of cholelithiasis in the pediatric population is complex, ranging from asymptomatic to life-threatening. Understanding the course of the disease and predisposing factors can result in a faster diagnosis of the disease and administration of appropriate treatment.

Relationship between cholelithiasis and metabolic syndrome: the role of genetic factors

The incidence of gallstone disease (GSD) and metabolic syndrome (MS) is increasing every year. The ICD-10 does not have the diagnosis of “metabolic syndrome” and it has been coded on the basis of the diseases despite its wide prevalence now. These are multifactorial diseases, the pathogenesis of which is intertwined and mutually aggravate their courses. There are both external and internal reasons of forming the stones in the biliary tract. Genetic factors play a significant role in the internal causes of cholelithiasis. The genetic characteristics of the patient allow to work out a personalized approach. It increases the success of drug therapy. MS is one of the main predisposing factors for the development of cholelithiasis. It also leads to more severe course of the latter. The pathogenetic mechanisms of the patologies developments are considered in the article presented with the special attention paid to the genetic component of cholelithiasis.

Probiotics for gallstone prevention in patients with bariatric surgery: A prospective randomized trial

Gall stone disease was known to increase after bariatric surgery. Ursodeoxycholic acid (UDCA) might reduce the gallstone formation rate after bariatric surgery. However, other option for gallstone prevention was unclear. We reported the result of a randomized trial comparing the gallstone prevention efficacy of probiotics and digestive enzyme versus UDCA. This prospective, randomized trial was held in an institute of Taiwan. Patients were eligible for inclusion if their body-mass index (BMI) was 32.5kg/m2 or higher with the presence of comorbidity, or 27.5kg/mw or higher with not-well controlled type 2 diabetes, and were aged 18-65 years. Participant were randomized assigned (1:1:1) to probiotic, digestive enzyme or UDCA. The primary endpoint was assessed in the incidence of gallstone disease at 6 months after surgery. This study is registered with ClinicalTrials.gov. number NCT03247101, and is now completed. From January 2016 to December 2018, of 186 patients screened for eligibility, 152 were randomly assigned to probiotic (52) or digestive enzyme (52) or UDCA (52). In the per-protocol population, mean age was 35.9 years (SD 10.6), mean BMI was 40.3kg/m2 (SD 6.9), 57(58.2%) were female. After 6 months, the incidence of gall bladder diseased was 15.2%, in the probiotics group, 17.6% in UDCA group and 29.1% in digestive enzyme groups, confirming non-inferiority of probiotic (p=0.38). Female gender was identified as a risk factor for gall bladder disease after bariatric surgery (odds ratio=4.61, 95% confidence interval=1.05, 20.3, p=0.04). The poor drug compliance rate was 19.5%, 22.7% and 26.2% in probiotics, UDCA and digestive enzyme group respectively. UDCA group had a higher drug adverse effect than probiotic group (15.9% vs. 2.4%, p=0.03). Probiotic is not inferior to UDCA regarding gall bladder disease prevention after bariatric surgery at 6 months.

Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study

PurposeThe incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea.MethodsThe National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends.ResultsThe ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017.ConclusionThis study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.

Hybrid Interventions in the Treatment of Common Bile Stones

In recent years, the incidence of gallstone disease has increased dramatically. Reports on the possibility of a one-stage minimally invasive treatment in the case of complicated cholecystocholedocholithiasis are increasingly found in the literature. Objective: To improve the immediate results of treatment of patients with "difficult” cholecystocholedocholithiasis. Materials and methods: 108 hybrid surgical interventions were performed between 2014 and 2020. Patients with "difficult” choledocholithiasis included with obstructive jaundice complicated by mild cholangitis and also with large single stones of AJP (with a diameter of more than 15 mm), with duodenal diverticula. All interventions were performed in an X-ray room using laparoscopic and endoscopic approach. The average age of the patients was 59.8 years old. Performed 64 laparoscopic cholecystectomy in combination with laparoscopic choledochotomy and lithoextraction. In these cases, the primary suture of the common bile duct was performed with bile duct drainage. 16 patients with duodenal diverticulum underwent a combination of laparoscopy with drainage, cannulation of bile duct and subsequent ERCP and lithoextraction. In 44 cases, simultaneous surgery included laparoscopy and ERCP. Results: The average duration of surgical intervention was 94.2±26.4 minutes, the hospitalization duration was 9.6±4.2 days. In 4 (3.7%) case, residual choledocholithiasis was observed, requiring repeated endoscopic lithoextraction. There were no other complications and deaths. So, hybrid surgical interventions can be used for the simultaneous treatment of patients with complicated cholecystocholedocholithiasis, further accumulation of experience and analysis of the results of these interventions are required.

Choledocholithiasis as a cause of obstructive jaundice after pancreatoduodenal resection

Obstructive jaundice is one of the main symptoms of diseases of hepatobiopancreatoduodenal region organs and occurs in 12.0-45.2% of cases. The article describes a clinical case of successful treatment of a patient with choledocholithiasis that occurred three years after gastropancreatoduodenal resection performed for pancreatic head cancer. Patients often die before they develop long-term postoperative complications, among which we can distinguish cicatricial strictures of biliodigestive anastomosis, which occur in 0.8% of cases, and the development of obstructive jaundice, which is primarily characteristic of the progression of the underlying disease or relapse. While analyzing the literature, we didnt find any statistically significant data regarding the incidence of gallstone disease (cholelithiasis) as a cause of obstructive jaundice in the patients after pancreatoduodenal resection. Thus, the clinical case presented below is of particular interest.

Risk factors for gallstone disease in Shanghai: An observational study.

The purpose of this study was to evaluate related risk factors for gallstone disease in Shanghai.We analyzed successive physical examinations of 2288 adults who were recruited at the Jinshan Branch of the Sixth People's Hospital of Shanghai and Jinshan Hospital Affiliated to Fudan University Hospital from July 2010 to December 2012. The odds ratios (ORs) with 95% confidence intervals (CIs) were used to measure the influence factors on the risks of gallstone development.The incidence of gallstone disease was 4.11% (94/2,288). Older age (OR: 1.02; 95% CI: 1.00–1.03; P = .039), higher body weight (OR: 1.02; 95% CI: 1.00–1.04; P = .021), alanine transaminase activity (ALT) (OR: 1.02; 95% CI: 1.01–1.03; P = .001), total standard bicarbonate (SB) (OR: 1.04; 95% CI: 1.02–1.06; P < .001), free SB (OR: 1.17; 95% CI: 1.12–1.21; P < .001), and low density lipoprotein (LDL) levels (OR: 1.59; 95% CI: 1.32–1.91; P < .001) were associated with an increased risk of gallstone disease. Based on univariate logistic analysis, increased triglyceride (TG) levels were associated with a reduced risk of gallstone disease (OR: 0.76; 95% CI: 0.60–0.97; P = .024). The results of multivariable logistic regression analysis showed higher LDL levels correlated with an increased risk of gallstone disease (OR: 1.92; 95% CI: 1.31–2.81; P < .001), while age, weight, ALT, total SB, free SB, and TG levels did not affect the risk of gallstone disease.The although unadjusted results showed age, weight, ALT, total SB, free SB, TG, and LDL levels to be associated with the risk of gallstone disease, adjusting for potential factors revealed only increased LDL levels to be associated with an increased risk of gallstone disease.

Diagnosis of Helicobacter pylori in cholelithiasis and cholecystitis: by histology and serological association

Background: Biliary calculus disease is one of the most common disorders affecting the gastrointestinal tract. It is an important cause of morbidity. There has been marked rise in the incidence of gall stone disease in the west. In India, it is more common in northern states than in South India. Incidence of gallstones increases with age with a male to female ratio of 1:4. About 50% of these patients are asymptomatic.Methods: An analytical prospective study on patients diagnosed with cholecystitis and/or cholelithiasis was conducted in R. L. Jalappa Hospital Tamaka, Kolar. 58 patients were included in the study between June 2018 and May 2019. Data was collected and analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions.Results: The age incidence was found to be highest between 31 to 40 years. The incidence of cholelithiasis was more in females. All patients presented with pain abdomen. Calculous cholecystitis was the most common mode of presentation. Open cholecystectomy was commonly done for cholelithiasis in our set up. Chronic calculous cholecystitis is the commonest histopathology.Conclusions: According to our findings evidence of recent and chronic infection Helicobacter pylori as shown by demonstration of IgM and IgG class of antibodies respectively to the organism was found in most of patients and histological evidence of the patients with cholecystitis and cholelithiasis. Thus, the frequency of helicobacter infection seems to be low in the patient population studied.

Routine Pathology and Postoperative Follow-Up are Not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease

IntroductionThe incidence of gallstone disease is increasing and represents a strain on healthcare systems worldwide. Following cholecystectomy, gallbladder specimens are generally submitted for histopathologic examination and the diagnostic yield of this strategy remains questionable. This study aimed to evaluate the usefulness of routine pathologic examination of the gallbladder specimens and investigate the results of routine postoperative follow-up visits.MethodsAll cholecystectomies performed between January 2011 and July 2017 at a single center were evaluated. All gallbladder specimens were routinely pathologically examined. The outcome parameters were the macro- and microscopic gallbladder anomalies at pathology and the reported symptoms during routine follow-up visits 2–6 weeks after surgery.ResultsIn the study period a total of 2763 patients underwent cholecystectomy, of which 2615 had a postoperative visit in the outpatient clinic. Seventy-three patients (3%) complained of persistent abdominal pain, and 29 of these patients were referred for further treatment, resulting in a resolution of symptoms in 97%. Of all gallbladder specimens, 199 (7%) displayed macroscopic anomalies and in four (2%) of these, gallbladder carcinoma was diagnosed.DiscussionSelective pathologic examination of gallbladder specimens in case of macroscopic anomalies appears justified. Also routine follow-up after cholecystectomy appears not useful since 97% of patients do not report any symptoms at follow-up. A selective pathology and follow-up strategy could save significant healthcare costs.

Incidence of gallstone disease and complications.

The purpose of this review was to describe the epidemiology of gallstone disease in the era of ultrasound screening and laparoscopic cholecystectomy. Recent general population cohorts, including ultrasound screenings, have contributed to our understanding of formation and clinical course of gallstone disease. Cohorts of symptomatic gallstone disease have been informative about symptom recurrence and need of treatment. Preventive targets for gallstone formation may include obesity and the associated metabolic changes. The presence of gallstone disease is best described as a continuum from asymptomatic to symptomatic disease, with the latter including both pain attacks and complicated disease. Symptomatic disease causes a persistent high risk of symptom recurrence and need of cholecystectomy. The majority of gallstone carriers will remain asymptomatic and about one in five will develop symptoms. Determinants of disease progression from asymptomatic to symptomatic disease include sex, age, body mass index, and gallstone ultrasound characteristics. Because of the absence of effective gallstone formation prevention, targets against the metabolic changes in obesity should be further explored in randomized controlled trials. To optimize patient selection for cholecystectomy, treatment algorithms including identified determinants of symptomatic disease in gallstone carriers should be explored in prospective clinical trials.

Comparison between early and late cholecystectomy after gallstone pancreatitis

Acute biliary pancreatitis is one of the most common gastrointestinal illnesses necessitating inpatient hospital admission. With an increasing incidence of gallstone disease, in the setting of a changing healthcare landscape, surgical indications must be carefully examined. The principles of management, including common duct clearance, bowel rest, and interval cholecystectomy to avoid recurrent disease have not changed, however with the refi nement of minimally invasive techniques, timing of intervention deserves re-examination. We seek to make evidence based recommendations on the timing of cholecystectomy following acute biliary pancreatitis.

Incidence and Risk of Gallstone Disease in Gilbert's Syndrome Patients in Indian Population

Individuals with Gilbert's syndrome (GS) harbor mutations in the UGT1A1 gene and are known to have elevated levels of bilirubin, which enhances the risk for gall stone formation. The aim of this study is to screen Indian patients with GS for the incidence of gall stone disease. Individuals with persistently elevated serum bilirubin levels were genotyped for two polymorphisms (rs8175347; rs4148323) in UGT1A1 gene to confirm GS in them. Flanking regions of the above polymorphisms were amplified followed by direct sequencing. Ultrasonography was done to detect gallstone disease. Clinical data, including assessment of liver function, circulating levels of total and direct bilirubin, as well as routine hematological parameters were obtained as per standard procedures (Autoanalyzer). Of the total 1621 individuals subjected to genotyping, 1191 (1149 males of 29.6±11.3 years with mean BMI of 22.1±3.7kg/m2 and 42 females of 30.8±14.8 years with mean BMI of 20.9±3.7kg/m2) were confirmed to have GS. Gall bladder abnormalities including cholelithiasis (n=106/1191; 8.9%), polyps (n=18/1191; 1.5%) and gallbladder wall thickening (n=17/1191; 1.4%) were noted. Incidence of gall stone disease was observed in 103 males (out of 1149) and 3 females (out of 42) indicating the risk of the disease to be 9.0% and 7.1% respectively in males and females with GS. Early recognition of GS by genetic analysis is required before these patients with intermittent episodes of jaundice run the risk of unnecessary operations on their bile ducts from the mistaken assumption ascribing the jaundice to a stone which has been left behind.

G75(P) Gallstone Disease in Children: Do Doctors Need More Guidance?

AimsTo highlight the difficulty in making the diagnosis and the lack of clear guidance for managing gallstone diseases in children using four cases that were diagnosed on our unit. Gallstone...

Review of the Impact of Antineoplastic Therapies on the Risk for Cholelithiasis and Acute Cholecystitis

Development of cholecystitis in patients with malignancies can potentially disrupt their treatment and alter prognosis. This review aims to identify antineoplastic interventions associated with increased risk of cholecystitis in cancer patients. A comprehensive search strategy was developed to identify articles pertaining to risk factors and complications of cholecystitis in cancer patients. FDA-issued labels of novel antineoplastic drugs released after 2010 were hand-searched to identify more therapies associated with cholecystitis in nonpublished studies. Of an initial 2,932 articles, 124 were reviewed in the study. Postgastrectomy patients have a high (5-30 %) incidence of gallstone disease, and 1-7 % develop symptomatic disease. One randomized trial addressing the role of cholecystectomy concurrent with gastrectomy is currently underway. Among other risk groups, patients with neuroendocrine tumors treated with somatostatin analogs have a 15 % risk of cholelithiasis, and most are symptomatic. Hepatic artery based therapies carry a risk of cholecystitis (0.02-24 %), although the risk is reduced with selective catheterization. Myelosuppression related to chemotherapeutic agents (0.4 %), bone marrow transplantation, and treatment with novel multikinase inhibitors are associated with high risk of cholecystitis. There are several risk factors for gallbladder-related surgical emergencies in patients with advanced malignancies. Incidental cholecystectomy at index operation should be considered in patients planned for gastrectomy, and candidates for regional therapies to the liver or somatostatin analogs. While prophylactic cholecystectomy is currently recommended for patients with cholelithiasis receiving myeloablative therapy, this strategy may have value in patients treated with multikinase inhibitors, immunotherapy, and oncolytic viral therapy based on evolving evidence.

Fibroblast growth factor receptor 4 Gly388Arg polymorphism associated with severity of gallstone disease in a Chinese population

The etiology of gallstone disease is multifactorial; supersaturation of bile with cholesterol is a primary cause for gallstone formation. In previous studies, we found that fibroblast growth factor receptor 4 (FGFR4) plays an important role in maintaining bile acid homeostasis by regulating the expression of cholesterol 7α-hydroxylase (CYP7A1), a rate-limiting enzyme for bile acid biosynthesis. The Gly388Arg (G-388R) polymorphism of FGFR4 affects stabilization and activation of FGFR4. Consequently, we studied the FGFR4 gene as a candidate gene for genetic susceptibility to gallstone disease. We found that overexpression of FGFR4, especially the G-388R mutant of FGFR4, inhibits luciferase activity of CYP7A1 reporter in HepG2 cells, indicating that the G-388R mutant of FGFR4 may have greater inhibitory activity against bile acid biosynthesis. To investigate the association of FGFR4 polymorphism with gallstone disease, 117 patients with gallstone disease and 457 controls were genotyped for FGFR4 polymorphism G-388R by PCR-RFLP. Although the incidence of gallstone disease was not greater in patients with the FGFR4 RR genotype, the ratio of gallstone patients with acute cholecystitis in the FGFR4 RR genotype (42%) was significantly higher than that in other genotypes of FGFR4 (P = 0.019). In conclusion, the FGFR4 polymorphism is a genetic risk factor contributing to aggravation of gallstone disease.

ERCP in Obese Patients: A Retrospective Analysis of Efficacy and Safety

Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure in the management of pancreato-biliary diseases. It is well documented that the incidence of gallstone disease is increased in obese patients hence an increased demand for ERCP in this patient population. The aim of this study is to compare the efficacy and safety of ERCP in obese patients versus non-obese patients. Methods: We retrospectively reviewed all consecutive ERCP cases performed in Bronx-Lebanon Hospital from January 2007-November 2010. We sequentially compared the endoscopic records of obese patients (BMI ≥ 30) and nonobese patients (BMI < 30) in the study period. The primary outcome measures were indications, cannulation success rate, ERCP findings, interventions, periprocedure respiratory or cardiac complications and post-ERCP complications. Results: A total of 220 ERCP procedures were performed out of which 76 cases were performed in obese patients compared to 144 in non-obese patients. The mean age was 48.4 in the obese group and 42.1 in the non-obese group while the mean BMI was 36.8 and 25.3 in obese and non-obese patients respectively. The cannulation success rate was lower in the obese patients (81.5% vs 94% P = 0.01). The most common indication for ERCP was suspected CBD stones in both groups (82% in obese patients vs 66% in non-obese patients). Peri-procedure cardiac or respiratory complications were similar in both groups and post-procedure complications including pancreatitis (6.5% vs 7.6% P = 0.809), perforation (1.32% vs 0% P = 0.782) and bleeding (0% vs 2.1% P = 0.463) were not significantly different in the obese group versus the non-obese group. Conclusion: Obese patients carry similar risks of post-ERCP complications and peri-procedure cardiac or respiratory complications as non-obese patients. However, the cannulation success rate was lower in this group of patients compared to non-obese patients.

Treatment of Symptomatic Gallstones with Chinese Herbs

Purpose: Introduction: The best therapy for symptomatic gallstones is considered to be surgical, preferably with laparoscopic cholecystectomy. Dissolution is considered in patients who cannot tolerate, or refuse, surgery. We present a case of young gentleman who opted alternative medical treatment using chinese herbs successfully. Methods: Case: We are presenting a case of 37 year old male of chinese descent with 6 month history of epigastric/right upper quadrant pain, bloating, gas and dyspepsia. He had an ultrasound done that suggested multiple small mobile gallstones. He consulted a surgeon and was recommended to have cholecystectomy. He was highly skeptical to have surgery, and decided to take Chinese herbal treatment. He received four 15 day sessions, for a total of 60 days. Each session consisted of ½ gallon tea and 42 pills daily. The tea was made in ½ gallon boiling water to be mixed with multiple tea bags including full body cleansing tea, liver formula tea, bladder formula tea, and organic honey. The pills included kidney tonic I, ureter formula, spleen tonic, pancreas formula, liver tonic and stomach formula. The 1st and 2nd sessions were identical. The 3rd and 4th session had a minor change where origanum tea was added and honey was increased. After completion of this therapy, his GI symptoms improved. A repeat ultrasound revealed no further evidence of gallstones. Results: Discussion: The primary treatment of symptomatic gallstones is surgical. Medical therapy is considered in patients who cannot tolerate, or refuse, surgery. Non- surgical treatment consist of oral bile salt dissolution or extracorporeal shock wave lithotripsy (ESWL). Medical management is rarely used because of duration of treatment needed and the high risk of recurrence. Use of ESWL is extremely rare. The most frequently used medicine is UDCA (Ursodeoxycholic acid). The success rate is variable and the duration of treatment may be long, lasting up to 12-24 months. We present a case where Chinese herbal treatment was utilized by the patient that resulted in dissolution of stones within 60 days. Conclusion: Symptomatic gallstone disease is very common. Surgical treatment is the mainstay of therapy. The incidence of gallstone disease is likely to rise in the country in view of the changing population dynamics and increasing obesity. The rising health care cost will make is difficult to cope with escalating demand for cholecystectomies. Medical management of selected cases of symptomatic cholelithiasis need to be studied further. A combined research effort by conventional evidence based medicine with alternative medicine may prove to be helpful in finding novel treatment modalities.