Patients with asymptomatic course of cholelithiasis, assessment of risk factors for complications and selection of patient groups for surgical treatment
https://doi.org/10.17238/2072-3180-2022-12-21
Abstract
The article reviews works on the treatment of patients with asymptomatic cholelithiasis. Cholelithiasis is common in 10-13% of the population, but only 13-22% develop symptoms of the disease and complications. The article examines how views on the problem of treatment of cholelithiasis have been changing with the introduction of new technologies: ultrasound examination of the abdominal cavity, which made it possible to identify a significant number of patients with cholelithiasis. The introduction of laparoscopic cholecystectomy significantly facilitated surgical treatment for the patient and allowed to expand the indications for cholecystectomy.
At the moment, there are different points of view on the need for surgical treatment of cholelithiasis. Some consider that cholecystomy is the only method of treating patients with cholelithiasis. However, most authors believe that in asymptomatic cholelithiasis, a wait-and-see tactic is more justified, and even extend this tactic to patients with a previous episode of cholecystitis.
Among asymptomatic patients with cholelithiasis, there are groups of patients with a high risk of complications for whom surgical treatment is justified: Porcelain gallbladder, macro- and micro-lithiasis, multiple gallstones, disconnected gallbladder, hemolytic anemia. Besides, the necessity of cholecystectomy in patients with gallstones undergoing surgery on abdominal organs for another disease is also being discussed.
Dividing patients with asymptomatic cholelithiasis into those for whom surgical treatment is preferable and those who are sufficiently monitored will reduce the number of complications of cholelithiasis and reduce the burden on Healthcare. However further clinical studies are needed to determine the treatment tactics for some groups of patients.
Keywords
asymptomatic cholelithiasis,
cholecystectomy,
complications of cholelithiasis,
porcelain gallbladder
Supporting agencies: The study was carried out as part of the project of the Department of Health of the city of Moscow "Scientific laboratory" Moscow polyclinic.
About the Author
I. N. Agafonov
State Budgetary Healthcare Institution "City Polyclinic № 23 of the Moscow City Health Department"
Russian Federation
Russian Federation
Agafonov Igor Nikolaevich – Ph.D., surgeon
109431, Moscow, Aviakonstruktora Mil str., 6, p. 1
References
1. Uspenskiy Y.P., Ivanov S.V., Vovk A.V. The evolution of approaches to the gallstone disease treatment. Diary of the Kazan medical school, 2018, № 4 (22), рр. 109–116.
2. Diagnosis and management of gallstone disease: summary of NICE guidance. BMJ, 2014, № 349, р. 6241. https://doi.org/10.1136/bmj.g6241
3. Ivashkin V.T., Maev I.V., Baranskaya E.K. i dr. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of cholelithiasis. Russian Journal of Gastroenterology, Hepatology, Coloproctology, 2016, № 3: 64–80. (In Russian).
4. Ruban A.P., Bagmet A.D. Cholelithiasis, cholecystectomy-what’s next? Spa medicine, 2014, № 3, рр. 97–103. (In Russian)
5. Goenka M.K., Shah B.B., Rodge G.A., Rai V.K., Afzalpurkar S., Agarwal R., Goenka U. Efficacy and safety of cholangioscopy guided laser lithotripsy for difficult bile duct stones - A prospective study from a tertiary care centre in Eastern India. Arab J Gastroenterol., 2021, Jun; № 22(2), рр. 111–114. https://doi.org/10.1016/j.ajg.2021.05.012
6. Alimov I.A., Aliev F.S., Kruchinin E.V, Komarova L.N., Mandrichenko A.S., Alimov A.I., Petrov V.G., Alborov R.G., Saveiyev N.N. Comparative characteristics of laparoscopic cholecystectomy and cholecystectomy from mini-access according to the results of the surgical department of the Tyumen Hospital of the FGBUZ ZSMC FMBA of RUSSIA. Medical Science and Education of the Urals, 2019, Vol. 20, № 3 (99), pp. 122–125. (In Russian)
7. Halldestam I., Enell E.L., Kullman E., Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg., 2004, Jun; № 91(6), № 734–348. https://doi.org/10.1002/bjs.4547
8. European Association for the Study of the Liver (EASL). Electronic address: easloffice@easloffice.eu. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol., 2016, Jul; № 65(1), рр. 146–181. https://doi.org/10.1016/j.jhep.2016.03.005
9. Fedorov I.V. History of biliary surgery. Kazan Medical Journal, 2014, Vol. 95, № 4, рр. 604–607. (In Russian)
10. Craig A.B., Adams D. В Who did the first laparoscopic cholecystectomy? J Minim Access Surg., 2011, № 7(3), рр. 165–168. https://doi.org/10.4103/0972-9941.83506
11. Shabanzadeh D.M. Incidence of gallstone disease and complications. Curr Opin Gastroenterol., 2018, Mar; № 34(2), рр. 81–89. https://doi.org/10.1097/MOG.0000000000000418
12. Tsukanov V.V., Vasutin A.V., Tonkih U.L. Цуканов В.В., Васютин А.В., Тонких Ю.Л. Modern aspects of the pathogenesis and treatment of cholelithiasis. Siberian Medical Journal (Irkutsk), 2015, Vol. 132, № 1, рр. 10–14. (In Russian)
13. Sheng B., Zhao Q., Ma M., Zhang J. An inverse association of weight and the occurrence of asymptomatic gallbladder stone disease in hypercholesterolemia patients: a case-control study. Lipids Health Dis., 2020, Oct; № 23;19(1), рр. 228. https://doi.org/10.1186/s12944-020-01402-8
14. Dorofeenkov M.E., Li E.D., Kuznetsov O.O., Konev U.V. Risk factors, features of the clinical course and prevalence of cholelithiasis in elderly and senile people in Moscow. Clinical gerontology, 2013, Vol. 19, № 3–4, рр. 30–35. (In Russian)
15. Ali A., Perveen S., Khan I., Ahmed T., Nawaz A., Rab A. Symptomatic Gallstones in Young Patients Under the Age of 30 Years. Cureus., 2021, Nov; № 25;13(11), рр. e19894. https://doi.org/10.7759/cureus.19894
16. Ibrahim M., Sarvepalli S., Morris-Stiff G., Rizk M., Bhatt A., Walsh R.M., Hayat U., Garber A., Vargo J., Burke C.A. Gallstones: Watch and wait, or intervene? Cleve Clin J Med., 2018, Apr; № 85(4), рр. 323–331. https://doi.org/10.3949/ccjm.85a.17035
17. Jones M.W., Weir C.B., Ghassemzadeh S. Gallstones (Cholelithiasis). 2022, Apr; № 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
18. Firsova V.G., Parschikov V.V., Kykosch M.V., Gradusov V.P., Rotkov A.I., Termov S.A., Artifeksova A.A., Potehina U.P. Cholelithiasis: The possibilities of a differentiated approach to treatment and unresolved issues. Medical almanac, 2011, № 2 (15), рр. 78–82. (In Russian)
19. Thiyagarajan M., Kamaraj E., Navrathan N., Thyagarajan M., Singh Krishna B. Role of 99mTc-HIDA Scan for Assessment of Gallbladder Dyskinesia and Comparison of Gallbladder Dyskinesia with Various Parameters in Laparoscopic Cholecystectomy Patients. Minim Invasive Surg., 2019, Feb; № 14, рр. 5705039. https://doi.org/10.1155/2019/5705039
20. Bhaumik K. Asymptomatic Cholelithiasis in Children: Management Dilemma. J Indian Assoc Pediatr Surg., 2021, Jul-Aug; № 26(4), рр. 228–233. https://doi.org/10.4103/jiaps.JIAPS_107_20
21. Cao Z., Wei J., Zhang N. Liu W., Hong T., He X., Qu Q. Risk factors of systematic biliary complications in patients with gallbladder stones. Ir J Med Sci., 2020, Aug; № 189(3), рр. 943–947. https://doi.org/10.1007/s11845-019-02161-x
22. Litvinova N.V., Osipenko M.F. The structure of clinical syndromes and prognostic factors of their development after cholecystectomy in patients with cholelithiasis. Byull. SO RAMN, 2009, № 3, рр. 105–109. (In Russian)
23. Gupta S.C., Misra V., Singh P.A., Roy A., Misra S.P., Gupta A.K. Gall stones and carcinoma gall bladder. Indian J Pathol Microbiol., 2000, Apr; № 43(2), рр. 147–154. PMID: 11217272.
24. Gach T., Bogacki P., Markowska B., Bonior J., Paplaczyk M., Szura M. Quality of life in patients after laparoscopic cholecystectomy due to gallstone disease - evaluation of long-term postoperative results. Pol Przegl Chir., 2021, Oct 20, № 93(0), рр. 19–24. https://doi.org/10.5604/01.3001.0015.4213
25. Qudeer M.A., Naqi S.A., Sarwar M.Z., Mujahid H.A. Frequency of gall bladder carcinoma in cholecystectomies performed for symptomatic cholelithiasis. J Pak Med Assoc., 2021, Feb; № 71(2(B), рр. 779. https://doi.org/10.47391/JPMA.660
26. Cariati A., Piromalli E., Cetta F. Gallbladder cancers: associated conditions, histological types, prognosis, and prevention. Eur J Gastroenterol Hepatol., 2014, May; № 26(5), рр. 562–569. https://doi.org/10.1097/MEG.0000000000000074
27. Ransohoff D.F., Gracie W.A., Wolfenson L.B., Neuhauser D. Prophylactic cholecystectomy or expectant management for silent gallstones. A decision analysis to assess survival. Ann Intern Med., 1983, № 99, рр. 199–204. https://doi.org/10.7326/0003-4819-99-2-199
28. Frost F., Kacprowski T., Rühlemann M., Weiss S., Bang C., Franke A., Pietzner M., Aghdassi A.A., Sendler M., Völker U., Völzke H., Mayerle J., Weiss F.U., Homuth G., Lerch M.M. Carrying asymptomatic gallstones is not associated with changes in intestinal microbiota composition and diversity but cholecystectomy with significant dysbiosis. Sci Rep., 2021, Mar 23. № 11(1), рр. 6677. https://doi.org/10.1038/s41598-021-86247-6
29. Bencini L., Marchet A., Alfieri S., Rosa F., Verlato G., Marrelli D., Roviello F., Pacelli F., Cristadoro L., Taddei A., Farsi M. Italian Research Group for Gastric Cancer (GIRCG). The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer-a randomized-controlled trial. Gastric Cancer, 2019, May; № 22(3), рр. 632–639. https://doi.org/10.1007/s10120-018-0879-x
30. Morris-Stiff G., Sarvepalli S., Hu B., Gupta N., Lal P., Burke C.A., Garber A., McMichael J., Rizk M.K., Vargo J.J., Ibrahim M., Rothberg M.B. The Natural History of Asymptomatic Gallstones: A Longitudinal Study and Prediction Model. Clin Gastroenterol Hepatol., 2022, May, № 2, рр. S1542-3565(22)00435-9. https://doi.org/10.1016/j.cgh.2022.04.010
31. Ransohoff D.F., Gracie W.A. Treatment of gallstones. Ann Intern Med., 1993, № 119, рр. 606–619. https://doi.org/10.7326/0003-4819-119-7_part_1-199310010-00010
32. Styzhkina S.N., Gumerova G.N., Nurieva A.I., Schaihutdinoba A.M. Analysis of clinical manifestations of cholelithiasis and risk factors. Modern Science, 2020, № 4–3, рр. 264–267. (In Russian)
33. Aggarwal M., Agarwal N., Mishra T.S., Sharma N., Singh S. Is laparoscopic cholecystectomy effective in relieving dyspepsia in patients of cholelithiasis? A prospective study. Trop Gastroenterol., 2016, Apr-Jun; № 37(2), рр. 86–92. PMID: 30234277
34. Vetrhus M., Soreide O., Solhaug J.H., Nesvik I., Sondenaa K. Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Scand J Gastroenterol., 2002, Jul; № 37(7), рр. 834–839. PMID: 12190099
35. Ahmed I., Innes K., Brazzelli M., Gillies K., Newlands R., Avenell A., Hernández R., Blazeby J., Croal B., Hudson J., MacLennan G., McCormack K., McDonald A., Murchie P., Ramsay C. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/ conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open., 2021, Mar 25; № 11(3), рр. 039781. https://doi.org/10.1136/bmjopen-2020-039781
36. Patel M.S., Thomas J.J., Aguayo X., Chaloupkova D., Sivapregasm P., Uba V., Sarwary S.H. Outcomes of Acute Gallstone Disease During the COVID-19 Pandemic: Lessons Learnt. Cureus, 2022, Jun 22; № 14(6), рр. 26198. https://doi.org/10.7759/cureus.26198
37. Johan Drott C., Sandblom G., Österberg J., Rogmark P., Enochsson L. Fler akuta gallstensoperationer och färre elektiva under pandemin [Swedish gallstone surgery during the covid-19 pandemic]. Lakartidningen. 2022, Jun 20; № 119, рр. 21230. PMID: 35723571
38. Grigorieva I.N., Romanova T.I. Quality of life in patients with cholelithiasis in the long-term period after cholecystectomy. Experimental and clinical gastroenterology, 2010, № 9, рр. 38–43. (In Russian)
39. Morimoto M., Matsuo T., Mori N. Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review. Diagnostics (Basel), 2021, Jun 10; № 11(6), рр. 1073. https://doi.org/10.3390/diagnostics11061073
40. Stephen A.E., Berger D.L. Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery, 2001, Jun; № 129(6), рр. 699–703. https://doi.org/10.1067/msy.2001.113888
41. Shi X., Jin S., Wang S., Tao W., Wang G. Gallbladder perforation in a patient with alcoholic liver cirrhosis and asymptomatic gallstones: A case report. Medicine (Baltimore), 2018, May; № 97(18), рр. 0414. https://doi.org/10.1097/MD.0000000000010414
42. Abbasi S.U., Khan D.B., Khandwala K., Raza R., Memon W.A. Cholecystocolonic Fistula. Cureus., 2019, Jun 10; № 11(6), рр. 4874. https://doi.org/10.7759/cureus.4874
43. Hoekstra E., van den Berg M.W., Veenendaal R.A., Stuyt R. The natural progression of a fistulizing gallstone resulting in massive gastrointestinal hemorrhage and Bouveret syndrome, a rare case. Clin J Gastroenterol., 2020, Jun; № 13(3), рр. 393–396. https://doi.org/10.1007/s12328-019-01054-x
44. Peixoto R., Correia J., Soares M.G., Gouveia A. Síndrome de Bouveret: Apresentação de Um Caso Clínico e Breve Revisão da Literatura [Bouveret’s Syndrome: A Case Report and a Brief Literature Review]. Acta Med Port., 2020, May 4; № 33(5), рр. 347–349. https://doi.org/10.20344/amp.11664
45. Chang C.W., Wu Y.H., Liu H.L. Upper Gastrointestinal Bleeding With Hemobilia Caused by Gallstones. J Emerg Med., 2020, May; № 58(5), рр. 227–229. https://doi.org/10.1016/j.jemermed.2020.03.035
46. Chan A.W., Sabaratnam R.M., Pillay Y. Massive gallstone in an asymptomatic Indigenous Canadian male: Case report and literature review. Int J Surg Case Rep., 2020, № 72, рр. 429–432. https://doi.org/10.1016/j.ijscr.2020.06.028
47. Bangash M., Alvi A.R., Shahzad N., Shariff A.H., Gill R.C. Factors Associated with Premalignant Epithelial Changes in Chronic Calculous Cholecystitis: A Case-Control Study. World J Surg., 2018. Jun; № 42(6), 1701–1705. https://doi.org/10.1007/s00268-017-4371-2
48. Biagini J. Asymptomatic cholelithiasis. When is a cholecystectomy justified? [Asymptomatic cholelithiasis. When is a cholecystectomy justified?] J Med Liban., 1989, № 38(1), рр. 51–55. PMID: 2519334
49. Johansson E., Österberg J., Sverdén E., Enochsson L., Sandblom G. Intervention versus surveillance in patients with common bile duct stones detected by intraoperative cholangiography: a population-based registry study. Br J Surg., 2021, Dec 1; № 108(12), рр. 1506–1512. https://doi.org/10.1093/bjs/znab324
50. Karpuz S., Attaallah W. Could cholecystectomy be abandoned after removal of bile duct stones by endoscopic retrograde cholangio-pancreaticography? Asian J Surg., 2021, Jul; № 44(7), рр. 939–944. https://doi.org/10.1016/j.asjsur.2021.01.013
51. Peter Shawn D., Kozlov YU. A. Diseases of the gallbladder in children - modern view of pediatric surgeon (systematic review). Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation, 2020, Vol. 10, № 1, рр. 7–16. (In Russian)
52. Cunningham R.M., Jones K.T., Kuhn J.E., Dove J.T., Horsley R.D., Daouadi M., Gabrielsen J.D., Petrick A.T., Parker D.M. Asymptomatic Cholelithiasis and Bariatric Surgery: Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass. Obes Surg., 2021, Mar; № 31(3), рр. 1249–1255. https://doi.org/10.1007/s11695-020-05125-8
53. Şen O., Türkçapar A.G. Risk of Asymptomatic Gallstones Becoming Symptomatic After Laparoscopic Sleeve Gastrectomy. Am Surg., 2021, Apr; № 18, рр. 31348211011107. https://doi.org/10.1177/00031348211011107
54. Della Penna A., Lange J., Hilbert J., Archid R., Königsrainer A., Quante M. Ursodeoxycholic Acid for 6 Months After Bariatric Surgery Is Impacting Gallstone Associated Morbidity in Patients with Preoperative Asymptomatic Gallstones. Obes Surg., 2019, Apr; № 29(4), рр. 1216–1221. https://doi.org/10.1007/s11695-018-03651-0
55. Haal S., Guman M.S.S., Boerlage T.C.C., Acherman Y.I.Z., de Brauw L.M., Bruin S., de Castro S.M.M., van Hooft J.E., van de Laar A.W.J.M., Moes D.E., Schouten M., Schouten R., van Soest E.J., van Veen R.N., de Vries C.E.E., Fockens P., Dijkgraaf M.G.W., Gerdes V.E.A., Voermans R.P. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial. Lancet Gastroenterol Hepatol., 2021, Dec; № 6(12), рр. 993–1001. https://doi.org/10.1016/S2468-1253(21)00301-0
56. Illige M., Meyer A., Kovach F. Surgical treatment for asymptomatic cholelithiasis. Am Fam Physician., 2014, Mar 15; № 89(6), рр. 468–470. PMID: 24695566.
57. Greyasov V. I., Chuguyevsky V.M., Sivokon N. I., Agapov M. A. Features of laparoscopic cholecystectomy in patients with chronic calculous cholecystitis and signs of “non-functioning” gallbladder. Annals of Surgical Hepatology, 2018, Vol. 23, № 2, рр. 93–99. (In Russian)
Review
For citations:
Agafonov I.N. Patients with asymptomatic course of cholelithiasis, assessment of risk factors for complications and selection of patient groups for surgical treatment. Moscow Surgical Journal. 2022;(5):12-21. (In Russ.) https://doi.org/10.17238/2072-3180-2022-12-21
Views:
389
Email this article 