Cholecystectomy rate following endoscopic biliary interventions

Sky Lim, Lin Naing, Vui Heng Chong

Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah (PAPRSB) Insitute of Health Science, Universiti Brunei Darussalam

ABSTRACT

Introduction: Gallstones disease is a common disorder and symptomatic disease is usually managed with surgery while those with common bile duct stones are usually managed with endoscopic intervention before proceeding to surgery. This study was intended to assess the rate of cholecystectomy among patients who had undergone ERC interventions, the reasons for not proceeding to cholecystectomy and related complications. Materials and Methods: Patients who had intact gallbladder and had undergone ERC for stones related complications over a two year period were retrospectively identified from the Endoscopic Unit Registry. Detailed case note reviews were conducted. Results: The overall cholecystectomy rate post-ERC interventions was 36.9% (48/130). Cholecystectomy was offered to 59.2% (n=77) and the uptake was only 58.4% (n=45/77). Among those who agreed for cholecystectomy, 11.1% (n=5/45) failed to turn up for their scheduled surgery. Three patients (6.7%) had symptoms recurrence before their scheduled surgery: two subsequently underwent cholecystectomy without ERC intervention and one who was pregnant was managed conservatively with holecystectomy. Among the patients who had declined cholecystectomy, 18.8% (n=6/32) had symptoms recurrence. Four patients required repeat ERC interventions and eventually all had cholecystectomy subsequently. The most common reason for declining cholecystectomy was ‘not keen’ and already asymptomatic (46.9%, n=15/32). Among patients who were not offerred cholecystectomy (n=53/130), symptoms recurrence occurred in 15.2% (n=7/53). Four patients required repeat ERC interventions and three subsequently underwent cholecystectomy. Conclusions: The cholecystectomy rate remains low after ERC interventions. Recurrence of symptoms necessating re-interventions occurred in patients offerred and not offerred cholecystectomy. The uptake rate should be improved and delay to cholecystectomy should be reduced to avoid symptoms recurrence. Patients not undergoing interventions should be advised regarding symptoms recurrence and should be monitored.

Keywords: Choledocholithiasis, cholecystectomy, endoscopic retrograde cholagiopancreatography, gallstones disease

Correspondence author: Vui Heng CHONG, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. Tel: +673 2242424 Ext 5233. E mail: chongvuih@yahoo.co.uk

Brunei Int Med J. 2012; 8 (4): 166-172